MEDICARE: AMERICAN DREAM ALF , INC.

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	3104A0630X	Assisted Living Facility (Behavioral Disturbances)
2	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	:	1881398675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN DREAM ALF , INC.

Provider Business Mailing Address
First Line	:	4532 W KNOLLWOOD ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-3636
Country	:	US
Telephone Number	:	786-419-8801
Fax Number	:	813-280-9418

Provider Business Practice Location Address
First Line	:	4532 W KNOLLWOOD ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-3636
Country	:	US
Telephone Number	:	786-441-9880
Fax Number	:	813-280-9418

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	RUBEIDY PEREZ GARCIA
Credential	:
Telephone Number	:	786-419-8801

Provider Enumeration Date	:	03/28/2023
Last Update Date	:	04/13/2023

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Directions to “AMERICAN DREAM ALF , INC. ” Practice Location

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