Provider Demographics
NPI:1669857264
Name:BRISTOL COURT ALF BSLC
Entity Type:Organization
Organization Name:BRISTOL COURT ALF BSLC
Other - Org Name:BRISTOL COURT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-809-6147
Mailing Address - Street 1:3479 54TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-2426
Mailing Address - Country:US
Mailing Address - Phone:727-580-8888
Mailing Address - Fax:727-580-7777
Practice Address - Street 1:3479 54TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33714-2426
Practice Address - Country:US
Practice Address - Phone:727-580-8888
Practice Address - Fax:727-580-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11970310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility