Provider Demographics
NPI:1790229656
Name:CONSUELO'S ALF II INC
Entity Type:Organization
Organization Name:CONSUELO'S ALF II INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MASSIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNALDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-775-8689
Mailing Address - Street 1:4335 WALLACE CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-3437
Mailing Address - Country:US
Mailing Address - Phone:813-775-8689
Mailing Address - Fax:813-839-7495
Practice Address - Street 1:4335 WALLACE CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-3437
Practice Address - Country:US
Practice Address - Phone:813-775-8689
Practice Address - Fax:813-839-7495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12923310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility