MEDICARE: ALL CARE SENIOR LIVING II, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043924780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL CARE SENIOR LIVING II, LLC

Provider Business Mailing Address
First Line	:	3479 54TH AVE N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33714-2426
Country	:	US
Telephone Number	:	727-685-0490
Fax Number	:

Provider Business Practice Location Address
First Line	:	3479 54TH AVE N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33714-2426
Country	:	US
Telephone Number	:	727-685-0490
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MOHAMED RAMZI CHABBAR
Credential	:
Telephone Number	:	813-486-3817

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	01/09/2023

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