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General NPI Number Information
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NPI Number | 1801154604
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Entity Type | Organization
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Legal Business Name | CATH E-Z LIVING FACILITY, LLC.
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 04/30/2012
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Provider Practice Location Address
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Address Line | 907 PINE RIDGE CIR E
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City | BRANDON
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State | FL
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Zip | 33511-6277
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Country | US
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Telephone | 813-685-5656
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Fax | 813-685-5656
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Provider Business Mailing Address
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Address Line | 601 OVERLAND DR
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City | BRANDON
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State | FL
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Zip | 33511-5940
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Country | US
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Telephone | 813-653-3945
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Fax | 813-689-9817
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CATHALENE SAMS KINSLER
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Credential | MSM
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Telephone | 813-685-5656
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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 | AL12127
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License Number State | FL
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