MEDICARE: ALONDRA'S ALF 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	AL12909	FL

General Provider Information

NPI Number	:	1689116139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALONDRA'S ALF LLC

Provider Business Mailing Address
First Line	:	1804 W FLORA ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5332
Country	:	US
Telephone Number	:	813-407-2971
Fax Number	:

Provider Business Practice Location Address
First Line	:	1804 W FLORA ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5332
Country	:	US
Telephone Number	:	813-407-2971
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. ALINA FELIX
Credential	:
Telephone Number	:	813-407-2971

Provider Enumeration Date	:	11/15/2016
Last Update Date	:	11/15/2016

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