Provider Demographics
NPI:1366044547
Name:RUSSO, FRANCIS ALBERTO
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:ALBERTO
Last Name:RUSSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 MAGNOLIA RD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-5743
Mailing Address - Country:US
Mailing Address - Phone:941-412-4092
Mailing Address - Fax:941-220-7352
Practice Address - Street 1:350 MAGNOLIA RD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5743
Practice Address - Country:US
Practice Address - Phone:941-412-4092
Practice Address - Fax:941-220-7352
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12776310400000X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home