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General NPI Number Information
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NPI Number | 1093056863
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Entity Type | Organization
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Legal Business Name | LA COLONIA II A.L.F. INC.
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Dates
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Enumeration Date | 03/04/2013
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Last Update Date | 03/04/2013
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Provider Practice Location Address
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Address Line | 637 SE 12TH CT
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City | CAPE CORAL
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State | FL
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Zip | 33990-2922
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Country | US
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Telephone | 239-574-1502
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Fax | 239-673-8056
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Provider Business Mailing Address
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Address Line | 637 SE 12TH CT
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City | CAPE CORAL
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State | FL
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Zip | 33990-2922
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Country | US
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Telephone | 239-574-1502
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Fax | 239-673-8056
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Authorized Official
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Title or Position | OWNER
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Name | MR. LAZARO FLORES
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Credential |
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Telephone | 239-247-9962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL12331
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License Number State | FL
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