MEDICARE: ABUELO FELIZ HOME 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	AL12964	FL

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	:	1063950087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUELO FELIZ HOME LLC

Provider Business Mailing Address
First Line	:	8625 MAY CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1733
Country	:	US
Telephone Number	:	813-495-3660
Fax Number	:

Provider Business Practice Location Address
First Line	:	8625 MAY CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1733
Country	:	US
Telephone Number	:	813-495-3660
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	OLGA LIDIA MOLANO
Credential	:
Telephone Number	:	813-495-3660

Provider Enumeration Date	:	02/09/2017
Last Update Date	:	02/09/2017

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