Provider Demographics
NPI:1114147378
Name:JJ PABLO,INC. DBA AZALEAS ALF
Entity Type:Organization
Organization Name:JJ PABLO,INC. DBA AZALEAS ALF
Other - Org Name:AZALEAS ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:MACANLALAY
Authorized Official - Last Name:PABLO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:813-715-0650
Mailing Address - Street 1:38906 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-3820
Mailing Address - Country:US
Mailing Address - Phone:813-715-0560
Mailing Address - Fax:813-782-3860
Practice Address - Street 1:38906 NORTH AVE
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-3820
Practice Address - Country:US
Practice Address - Phone:813-715-0560
Practice Address - Fax:813-782-3860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8473310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility