Provider Demographics
NPI:1295179802
Name:CINNAMON COVE ALF, INC
Entity Type:Organization
Organization Name:CINNAMON COVE ALF, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHANNUS
Authorized Official - Last Name:KRASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-842-2340
Mailing Address - Street 1:5641 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-2643
Mailing Address - Country:US
Mailing Address - Phone:727-842-2340
Mailing Address - Fax:
Practice Address - Street 1:5641 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2643
Practice Address - Country:US
Practice Address - Phone:727-842-2340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10949310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105788100Medicaid