Provider Demographics
NPI:1225302912
Name:D & M CARRALERO GROUP HOME LLC.
Entity Type:Organization
Organization Name:D & M CARRALERO GROUP HOME LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELISA
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-454-8460
Mailing Address - Street 1:7007 LAWNVIEW CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2951
Mailing Address - Country:US
Mailing Address - Phone:813-885-4652
Mailing Address - Fax:813-885-4652
Practice Address - Street 1:7007 LAWNVIEW CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2951
Practice Address - Country:US
Practice Address - Phone:813-885-4652
Practice Address - Fax:813-885-4652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherIRS