Provider Demographics
NPI:1376881052
Name:A CASA MANGO ALF
Entity Type:Organization
Organization Name:A CASA MANGO ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:727-422-8718
Mailing Address - Street 1:6800 MANGO AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2110
Mailing Address - Country:US
Mailing Address - Phone:727-345-4541
Mailing Address - Fax:
Practice Address - Street 1:6800 MANGO AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-2110
Practice Address - Country:US
Practice Address - Phone:727-345-4541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LORON INNOVATIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 12273310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility