Provider Demographics
NPI:1326564485
Name:LA GLORIA ALF, LLC
Entity Type:Organization
Organization Name:LA GLORIA ALF, LLC
Other - Org Name:LA GLORIA ALF, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:ITURRIAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-389-7790
Mailing Address - Street 1:6003 W KNOX ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-4443
Mailing Address - Country:US
Mailing Address - Phone:813-415-3002
Mailing Address - Fax:
Practice Address - Street 1:6003 W KNOX ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-4443
Practice Address - Country:US
Practice Address - Phone:813-415-3002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022300300Medicaid