Provider Demographics
NPI:1063036481
Name:LA ROSA ALF CORP
Entity Type:Organization
Organization Name:LA ROSA ALF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEITSY
Authorized Official - Middle Name:
Authorized Official - Last Name:LA ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-468-3205
Mailing Address - Street 1:1615 CARNEGIE CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-5621
Mailing Address - Country:US
Mailing Address - Phone:813-468-3205
Mailing Address - Fax:813-402-2596
Practice Address - Street 1:1615 CARNEGIE CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-5621
Practice Address - Country:US
Practice Address - Phone:813-468-3205
Practice Address - Fax:813-402-2596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL13473OtherAHCA