Provider Demographics
NPI:1033141437
Name:THE ALLEGRO AT COLLEGE HARBOR L.L.C.
Entity Type:Organization
Organization Name:THE ALLEGRO AT COLLEGE HARBOR L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-864-5432
Mailing Address - Street 1:4600 54TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-4664
Mailing Address - Country:US
Mailing Address - Phone:727-866-3124
Mailing Address - Fax:
Practice Address - Street 1:4600 54TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-4664
Practice Address - Country:US
Practice Address - Phone:727-866-3124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL6140310400000X
FLSNF1094096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL8HOtherBLUE CROSS PRVIDER IDENTI
FL105959Medicare ID - Type UnspecifiedPROVIDER NUMBER