Provider Demographics
NPI:1356640213
Name:AMOEDO'S ALF
Entity Type:Organization
Organization Name:AMOEDO'S ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUGO
Authorized Official - Middle Name:A
Authorized Official - Last Name:AMOEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-781-1777
Mailing Address - Street 1:3415 W IVY ST
Mailing Address - Street 2:3415 W IVY ST
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1502
Mailing Address - Country:US
Mailing Address - Phone:813-842-3453
Mailing Address - Fax:
Practice Address - Street 1:3415 W IVY ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1502
Practice Address - Country:US
Practice Address - Phone:813-842-3453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 11149385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL 11149OtherAGENCY FOR HEALTH CARE ADMINISTRATION