Provider Demographics
NPI:1093156622
Name:BACERRA-LEGASPI CARE CORP
Entity Type:Organization
Organization Name:BACERRA-LEGASPI CARE CORP
Other - Org Name:SMALLVILLE 1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADM/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGASPI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-354-9734
Mailing Address - Street 1:10144 BROWNWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-6624
Mailing Address - Country:US
Mailing Address - Phone:321-354-9734
Mailing Address - Fax:
Practice Address - Street 1:10144 BROWNWOOD AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-6624
Practice Address - Country:US
Practice Address - Phone:321-354-9734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10997310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility