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General NPI Number Information
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NPI Number | 1902559289
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Entity Type | Organization
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Legal Business Name | ILEANA'S CARE HOME INC
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Dates
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Enumeration Date | 01/27/2022
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 6401 W CLIFTON ST
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City | TAMPA
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State | FL
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Zip | 33634-5010
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Country | US
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Telephone | 201-741-5460
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Fax | 813-559-7301
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Provider Business Mailing Address
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Address Line | 6401 W CLIFTON ST
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City | TAMPA
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State | FL
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Zip | 33634-5010
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Country | US
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Telephone | 201-741-5460
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Fax | 813-559-7301
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ILEANA BERMUDEZ
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Credential |
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Telephone | 201-741-5460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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