Provider Demographics
NPI:1689052425
Name:MEMORIAL SWEET ALF
Entity Type:Organization
Organization Name:MEMORIAL SWEET ALF
Other - Org Name:LACASA ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER.
Authorized Official - Prefix:
Authorized Official - First Name:CANLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-598-4787
Mailing Address - Street 1:9318 MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615
Mailing Address - Country:US
Mailing Address - Phone:813-598-4787
Mailing Address - Fax:813-880-0740
Practice Address - Street 1:9318 MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614
Practice Address - Country:US
Practice Address - Phone:813-598-4787
Practice Address - Fax:813-880-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility