Provider Demographics
NPI:1336497080
Name:SERENITY HOME OF TAMPA ALF LLC
Entity Type:Organization
Organization Name:SERENITY HOME OF TAMPA ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-884-7195
Mailing Address - Street 1:6013 CRESTHILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615
Mailing Address - Country:US
Mailing Address - Phone:813-884-7195
Mailing Address - Fax:813-884-7195
Practice Address - Street 1:6013 CRESTHILL DRIVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615
Practice Address - Country:US
Practice Address - Phone:813-884-7195
Practice Address - Fax:813-884-7195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12218310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility