Provider Demographics
NPI:1285043026
Name:HONOR HOUSE ASSISTED LIVING FACILITY LLC
Entity Type:Organization
Organization Name:HONOR HOUSE ASSISTED LIVING FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSTY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LUDLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-210-7462
Mailing Address - Street 1:1912 DOVE FIELD PL
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2218
Mailing Address - Country:US
Mailing Address - Phone:813-210-7462
Mailing Address - Fax:
Practice Address - Street 1:1912 DOVE FIELD PL
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-2218
Practice Address - Country:US
Practice Address - Phone:813-210-7462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12421310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility