MEDICARE: CARING ANGELS FOR YOU ALF CORP

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	AL11637	FL

General Provider Information

NPI Number	:	1053751123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARING ANGELS FOR YOU ALF CORP

Provider Business Mailing Address
First Line	:	8006 W POCAHONTAS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-2912
Country	:	US
Telephone Number	:	813-374-3176
Fax Number	:	813-442-6033

Provider Business Practice Location Address
First Line	:	8006 W POCAHONTAS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-2912
Country	:	US
Telephone Number	:	813-374-3176
Fax Number	:	813-442-6033

Authorized Official
Title or Position	:	OWNER/ADMINISTRATION
Name	:	LIUT IVON DE LA ROSA
Credential	:
Telephone Number	:	813-270-5227

Provider Enumeration Date	:	07/03/2013
Last Update Date	:	07/03/2013

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