MEDICARE: ST.PETERSBURG ALF MANAGEMENT, 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

General Provider Information

NPI Number	:	1225822968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST.PETERSBURG ALF MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	435 42ND AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-4504
Country	:	US
Telephone Number	:	727-766-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 42ND AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-4504
Country	:	US
Telephone Number	:	727-766-0700
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	AMIT KEVIN PATEL
Credential	:
Telephone Number	:	727-766-0700

Provider Enumeration Date	:	04/07/2025
Last Update Date	:	08/26/2025

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