Provider Demographics
NPI:1508134636
Name:THE FRIENDLY HOUSE OF TAMPA BAY INC.
Entity Type:Organization
Organization Name:THE FRIENDLY HOUSE OF TAMPA BAY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-405-4949
Mailing Address - Street 1:2602 W COMANCHE AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-6175
Mailing Address - Country:US
Mailing Address - Phone:813-405-4949
Mailing Address - Fax:
Practice Address - Street 1:2602 W COMANCHE AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-6175
Practice Address - Country:US
Practice Address - Phone:813-405-4949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-04
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12101310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility