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General NPI Number Information
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NPI Number | 1932520004
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Entity Type | Organization
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Legal Business Name | NUEVA VIDA ALF II INC
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Dates
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Enumeration Date | 12/17/2013
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Last Update Date | 12/17/2013
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Provider Practice Location Address
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Address Line | 2827 MAX SMITH RD
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City | LUTZ
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State | FL
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Zip | 33559
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Country | US
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Telephone | 813-766-2376
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Fax | 813-388-9782
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Provider Business Mailing Address
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Address Line | 2827 MAX SMITH RD
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City | LUTZ
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State | FL
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Zip | 33559
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Country | US
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Telephone | 813-766-2376
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Fax | 813-388-9782
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RAYZA CAMMAN
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Credential |
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Telephone | 813-766-2376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | AL12442
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License Number State | FL
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