Provider Demographics
NPI:1700390069
Name:NORTHDALE ALF, INC.
Entity Type:Organization
Organization Name:NORTHDALE ALF, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPIGUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-598-2058
Mailing Address - Street 1:4815 CENTERBROOK CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1046
Mailing Address - Country:US
Mailing Address - Phone:813-961-5425
Mailing Address - Fax:813-963-1930
Practice Address - Street 1:4815 CENTERBROOK CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-1046
Practice Address - Country:US
Practice Address - Phone:813-961-5425
Practice Address - Fax:813-963-1930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-24
Last Update Date:2017-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12634310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility