Provider Demographics
NPI:1629438288
Name:SUN COAST ALF
Entity Type:Organization
Organization Name:SUN COAST ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTONIA
Authorized Official - Middle Name:EDELSA
Authorized Official - Last Name:IZNAGA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:786-357-0099
Mailing Address - Street 1:9111 SW 28TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3220
Mailing Address - Country:US
Mailing Address - Phone:786-357-0099
Mailing Address - Fax:305-554-0823
Practice Address - Street 1:9111 SW 28TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3220
Practice Address - Country:US
Practice Address - Phone:786-357-0099
Practice Address - Fax:305-554-0823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7958310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility