Provider Demographics
NPI:1881028835
Name:AMALIA GARDENS ALF LLC
Entity Type:Organization
Organization Name:AMALIA GARDENS ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AGLAY
Authorized Official - Middle Name:
Authorized Official - Last Name:FUMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-300-6726
Mailing Address - Street 1:2411 W NORTH B ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2375
Mailing Address - Country:US
Mailing Address - Phone:813-300-6726
Mailing Address - Fax:
Practice Address - Street 1:2411 W NORTH B ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2375
Practice Address - Country:US
Practice Address - Phone:813-300-6726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12253310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility