Provider Demographics
NPI:1831671775
Name:DE LAS MERCEDES ALF CORP
Entity Type:Organization
Organization Name:DE LAS MERCEDES ALF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAILY
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-785-2894
Mailing Address - Street 1:7012 N ORLEANS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-4734
Mailing Address - Country:US
Mailing Address - Phone:813-785-2894
Mailing Address - Fax:813-930-0545
Practice Address - Street 1:7012 N ORLEANS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-4734
Practice Address - Country:US
Practice Address - Phone:813-785-2894
Practice Address - Fax:813-930-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL126233104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12623OtherAHCA