Provider Demographics
NPI:1740778901
Name:LARRY'S FAMILY 1 CARE ALF, LLC
Entity Type:Organization
Organization Name:LARRY'S FAMILY 1 CARE ALF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGM
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-841-9823
Mailing Address - Street 1:4402 W MINNEHAHA ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3638
Mailing Address - Country:US
Mailing Address - Phone:813-841-9823
Mailing Address - Fax:813-999-1077
Practice Address - Street 1:4402 W MINNEHAHA ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614
Practice Address - Country:US
Practice Address - Phone:813-841-9823
Practice Address - Fax:813-999-1077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LARRY'S FAMILY 2 CARE ALF,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility