=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174783393
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE LOMBARDO HOME
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2008
-----------------------------------------------------
Last Update Date | 06/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 620 71ST STREET NORTH WEST
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-792-4845
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 620 71ST STREET NORTH WEST
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-792-4845
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. MARIA CONCEPCION LOMBARDO
-----------------------------------------------------
Credential | SOCIAL WORKER
-----------------------------------------------------
Telephone | 941-795-8819
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL11148
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------