Provider Demographics
NPI:1609147644
Name:CASA SANTA MARTHA ALF
Entity Type:Organization
Organization Name:CASA SANTA MARTHA ALF
Other - Org Name:CASA SANTA MARTHA ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-870-9086
Mailing Address - Street 1:1917 W MOHAWK AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1055
Mailing Address - Country:US
Mailing Address - Phone:813-870-9086
Mailing Address - Fax:813-870-9086
Practice Address - Street 1:1917 W MOHAWK AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1055
Practice Address - Country:US
Practice Address - Phone:813-870-9086
Practice Address - Fax:813-870-9086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12121310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility