Provider Demographics
NPI:1275811812
Name:SAINT LAZARUS ALF
Entity Type:Organization
Organization Name:SAINT LAZARUS ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:REINOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-492-0851
Mailing Address - Street 1:5209 LANDSMAN AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-3344
Mailing Address - Country:US
Mailing Address - Phone:813-963-0142
Mailing Address - Fax:813-374-1459
Practice Address - Street 1:5209 LANDSMAN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-3344
Practice Address - Country:US
Practice Address - Phone:813-963-0142
Practice Address - Fax:813-374-1459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility