Provider Demographics
NPI:1558671909
Name:YOUR HOUSE ALF 2
Entity Type:Organization
Organization Name:YOUR HOUSE ALF 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ORESTES
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-298-6909
Mailing Address - Street 1:5816 N GRADY AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5541
Mailing Address - Country:US
Mailing Address - Phone:813-298-6909
Mailing Address - Fax:813-374-5033
Practice Address - Street 1:5816 N GRADY AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5541
Practice Address - Country:US
Practice Address - Phone:813-298-6909
Practice Address - Fax:813-374-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility