Provider Demographics
NPI:1841777919
Name:KONA 66 LLC
Entity Type:Organization
Organization Name:KONA 66 LLC
Other - Org Name:KONA GARDENS ASSISTED LIVING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIRAG
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:813-967-3808
Mailing Address - Street 1:8447 DUNHAM STATION DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3339
Mailing Address - Country:US
Mailing Address - Phone:813-967-3808
Mailing Address - Fax:813-435-2244
Practice Address - Street 1:3200 66TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1511
Practice Address - Country:US
Practice Address - Phone:727-914-3012
Practice Address - Fax:727-914-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL13197310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility