MEDICARE: LILIAN ALF

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	AL11904	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	:	1659673309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILIAN ALF

Provider Business Mailing Address
First Line	:	1317 W RAMBLA ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-7737
Country	:	US
Telephone Number	:	813-270-6231
Fax Number	:	813-935-0758

Provider Business Practice Location Address
First Line	:	1317 W RAMBLA ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-7737
Country	:	US
Telephone Number	:	813-270-6231
Fax Number	:	813-935-0758

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LILIAN PENA
Credential	:
Telephone Number	:	813-270-6231

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	12/01/2010

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Directions to “LILIAN ALF ” Practice Location

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