Provider Demographics
NPI:1417351651
Name:LA BELLA VIDA ALF INC
Entity Type:Organization
Organization Name:LA BELLA VIDA ALF INC
Other - Org Name:LA BELLA VIDA ALF IV
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:INFANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-240-5478
Mailing Address - Street 1:7012 N ORLEANS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-4734
Mailing Address - Country:US
Mailing Address - Phone:813-240-5478
Mailing Address - Fax:
Practice Address - Street 1:7012 N ORLEANS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-4734
Practice Address - Country:US
Practice Address - Phone:813-240-5478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility