Provider Demographics
NPI:1942481767
Name:FASHGATE INVESTMENT, LLC
Entity Type:Organization
Organization Name:FASHGATE INVESTMENT, LLC
Other - Org Name:WELLSWOOD CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINUOLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FASONU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-965-1829
Mailing Address - Street 1:907 CLANTON AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:907 CLANTON AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1703
Practice Address - Country:US
Practice Address - Phone:813-232-2127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11509310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility