MEDICARE: YOUR HOUSE 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

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	:	1801194576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR HOUSE ALF CORP

Provider Business Mailing Address
First Line	:	4008 W BROAD ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-3164
Country	:	US
Telephone Number	:	813-298-6909
Fax Number	:

Provider Business Practice Location Address
First Line	:	4008 W BROAD ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-3164
Country	:	US
Telephone Number	:	813-298-6909
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ORESTES BERNAL
Credential	:
Telephone Number	:	813-298-6909

Provider Enumeration Date	:	03/04/2011
Last Update Date	:	03/04/2011

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Directions to “YOUR HOUSE ALF CORP ” Practice Location

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