Provider Demographics
NPI:1679944466
Name:GARDEN OASIS ALF, LLC
Entity Type:Organization
Organization Name:GARDEN OASIS ALF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:KANODEREKA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:813-530-0909
Mailing Address - Street 1:515 HICKORY LAKE DR STE B
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6337
Mailing Address - Country:US
Mailing Address - Phone:813-330-8424
Mailing Address - Fax:813-315-8233
Practice Address - Street 1:515 HICKORY LAKE DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6337
Practice Address - Country:US
Practice Address - Phone:813-699-4142
Practice Address - Fax:813-413-7740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12249310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility