Provider Demographics
NPI:1235772062
Name:BELLA VITA ALF-LAKE MAGDALENE
Entity Type:Organization
Organization Name:BELLA VITA ALF-LAKE MAGDALENE
Other - Org Name:UNA VITA LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:HOOVER
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-485-0316
Mailing Address - Street 1:13202 LAKE MAGDALENE BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-3008
Mailing Address - Country:US
Mailing Address - Phone:813-485-0316
Mailing Address - Fax:
Practice Address - Street 1:13202 LAKE MAGDALENE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-3008
Practice Address - Country:US
Practice Address - Phone:813-485-0316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility