Provider Demographics
NPI:1063836781
Name:YETEY ENTERPRISES INC
Entity Type:Organization
Organization Name:YETEY ENTERPRISES INC
Other - Org Name:IMMANUEL AT YBOR ASSISTED LIVING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ABIODUN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEGBOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-247-5852
Mailing Address - Street 1:8602 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-2104
Mailing Address - Country:US
Mailing Address - Phone:813-930-8370
Mailing Address - Fax:
Practice Address - Street 1:3213 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605
Practice Address - Country:US
Practice Address - Phone:813-247-5852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL107563104A0625X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005550800Medicaid