Provider Demographics
NPI:1093973364
Name:ALLEGIANCE PROPERTIES 1 INC DBA WESTBROOKE MANOR
Entity Type:Organization
Organization Name:ALLEGIANCE PROPERTIES 1 INC DBA WESTBROOKE MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:KLINOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-782-4417
Mailing Address - Street 1:6701 DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-6618
Mailing Address - Country:US
Mailing Address - Phone:813-782-4417
Mailing Address - Fax:813-782-8781
Practice Address - Street 1:6701 DAIRY RD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-6618
Practice Address - Country:US
Practice Address - Phone:813-782-4417
Practice Address - Fax:813-782-8781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL6061310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686528300Medicaid