Provider Demographics
NPI:1336504042
Name:CONSUELO'S ALF INC
Entity Type:Organization
Organization Name:CONSUELO'S ALF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MASSIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNALDO PAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-775-8689
Mailing Address - Street 1:4401 WEST BALLAST POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611
Mailing Address - Country:US
Mailing Address - Phone:813-775-8689
Mailing Address - Fax:813-839-7495
Practice Address - Street 1:4401 W BALLAST POINT BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-5601
Practice Address - Country:US
Practice Address - Phone:813-775-8689
Practice Address - Fax:813-839-7495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL124853104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012871100Medicaid