Provider Demographics
NPI:1457007031
Name:OUR LADY OF CHARITY ALF LLC
Entity Type:Organization
Organization Name:OUR LADY OF CHARITY ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YADIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-610-5470
Mailing Address - Street 1:7603 WINGING WAY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1521
Mailing Address - Country:US
Mailing Address - Phone:813-399-2199
Mailing Address - Fax:
Practice Address - Street 1:7603 WINGING WAY DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1521
Practice Address - Country:US
Practice Address - Phone:813-399-2199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility