Provider Demographics
NPI:1568999076
Name:BORMEY ASSISTED LIVING FACILITIES INC.
Entity Type:Organization
Organization Name:BORMEY ASSISTED LIVING FACILITIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISET
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-210-9669
Mailing Address - Street 1:6416 AMBASSADOR DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3402
Mailing Address - Country:US
Mailing Address - Phone:813-512-8569
Mailing Address - Fax:813-512-2576
Practice Address - Street 1:6416 AMBASSADOR DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3402
Practice Address - Country:US
Practice Address - Phone:813-512-8569
Practice Address - Fax:813-512-8569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-15
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13007310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020916400Medicaid