Provider Demographics
NPI:1346632163
Name:LA VIDA EN EL MAR ALF
Entity Type:Organization
Organization Name:LA VIDA EN EL MAR ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:Y
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:JR
Authorized Official - Credentials:LUIS
Authorized Official - Phone:813-770-0340
Mailing Address - Street 1:6802 ROSEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3318
Mailing Address - Country:US
Mailing Address - Phone:786-488-1075
Mailing Address - Fax:813-885-3810
Practice Address - Street 1:6802 ROSEWOOD CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3318
Practice Address - Country:US
Practice Address - Phone:786-488-1075
Practice Address - Fax:813-885-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12627261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherASSISTED LIVING FACILITY