Provider Demographics
NPI:1619297108
Name:POND'S EDGE ASSISTED LIVING FACILITY, INC.
Entity Type:Organization
Organization Name:POND'S EDGE ASSISTED LIVING FACILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAELANGELO
Authorized Official - Middle Name:ALANDY
Authorized Official - Last Name:DANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-788-0597
Mailing Address - Street 1:7952 PONDS EDGE LN
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33540-1972
Mailing Address - Country:US
Mailing Address - Phone:813-788-0597
Mailing Address - Fax:813-788-0056
Practice Address - Street 1:7952 PONDS EDGE LN
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540-1972
Practice Address - Country:US
Practice Address - Phone:813-788-0597
Practice Address - Fax:813-788-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9935310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9935OtherAHCA