Provider Demographics
NPI:1780007112
Name:TINA'S ASSISTED LIVING FACILITY CORP
Entity Type:Organization
Organization Name:TINA'S ASSISTED LIVING FACILITY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-375-1354
Mailing Address - Street 1:1172 TARPON AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-3745
Mailing Address - Country:US
Mailing Address - Phone:941-375-1354
Mailing Address - Fax:941-366-4945
Practice Address - Street 1:1172 TARPON AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-3745
Practice Address - Country:US
Practice Address - Phone:941-375-1354
Practice Address - Fax:941-366-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11606310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility