=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225984289
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANNIES ALF AT ORANGE GROVE DR LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2026
-----------------------------------------------------
Last Update Date | 03/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13315 ORANGE GROVE DR
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33618-2915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-485-0316
-----------------------------------------------------
Fax | 888-337-5377
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13444 CANOPY CREEK DR
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33625-5916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-494-7116
-----------------------------------------------------
Fax | 888-337-5377
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LATONIA BOYKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-485-0316
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------