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General NPI Number Information
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NPI Number | 1609147644
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Entity Type | Organization
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Legal Business Name | CASA SANTA MARTHA ALF
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Dates
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Enumeration Date | 01/23/2012
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 1917 W MOHAWK AVE
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City | TAMPA
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State | FL
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Zip | 33603-1055
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Country | US
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Telephone | 813-870-9086
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Fax | 813-870-9086
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Provider Business Mailing Address
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Address Line | 1917 W MOHAWK AVE
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City | TAMPA
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State | FL
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Zip | 33603-1055
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Country | US
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Telephone | 813-870-9086
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Fax | 813-870-9086
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | PEDRO AGUILA
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Credential |
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Telephone | 813-870-9086
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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 | AL12121
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License Number State | FL
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