Provider Demographics
NPI:1598971509
Name:THE HERITAGE OF TAVARES ALF
Entity Type:Organization
Organization Name:THE HERITAGE OF TAVARES ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:REY
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:ALAGANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-343-3070
Mailing Address - Street 1:900 E ALFRED ST
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-3402
Mailing Address - Country:US
Mailing Address - Phone:352-343-3070
Mailing Address - Fax:352-343-5633
Practice Address - Street 1:900 E ALFRED ST
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-3402
Practice Address - Country:US
Practice Address - Phone:352-343-3070
Practice Address - Fax:352-343-5633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5368310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility