Provider Demographics
NPI:1477862639
Name:ERIKA S HOUSE ASSISTED LIVING FACILITY LLC
Entity Type:Organization
Organization Name:ERIKA S HOUSE ASSISTED LIVING FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIEVES
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-728-5657
Mailing Address - Street 1:8301 N GOMEZ AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2814
Mailing Address - Country:US
Mailing Address - Phone:813-933-5953
Mailing Address - Fax:813-932-1925
Practice Address - Street 1:8301 N GOMEZ AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2814
Practice Address - Country:US
Practice Address - Phone:813-933-5953
Practice Address - Fax:813-932-1925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11880310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility