Provider Demographics
NPI:1821580895
Name:FOUNDATIONAL HEALTH ALF, INC.
Entity Type:Organization
Organization Name:FOUNDATIONAL HEALTH ALF, INC.
Other - Org Name:FOUNDATIONAL HEALTH ALF, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:LIANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ-URDANIVIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-391-5965
Mailing Address - Street 1:10591 BAY PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33708-3101
Mailing Address - Country:US
Mailing Address - Phone:727-391-5965
Mailing Address - Fax:727-289-7738
Practice Address - Street 1:10591 BAY PINES BLVD
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33708-3101
Practice Address - Country:US
Practice Address - Phone:813-477-3886
Practice Address - Fax:727-289-7738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7797310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility