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General NPI Number Information
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NPI Number | 1184029415
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Entity Type | Organization
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Legal Business Name | LONGLEAF ALF LLC
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Dates
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Enumeration Date | 10/29/2014
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Last Update Date | 10/29/2014
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Provider Practice Location Address
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Address Line | 3935 43RD AVE N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33714-3620
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Country | US
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Telephone | 727-289-5783
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Fax |
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Provider Business Mailing Address
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Address Line | 3935 43RD AVE N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33714-3620
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Country | US
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Telephone | 727-289-5783
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TAPAN B PATEL
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Credential | ADMIN
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Telephone | 727-289-5783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | AL12564
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License Number State | FL
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