Provider Demographics
NPI:1942636246
Name:FAMILY HOME CARE ALF, INC
Entity Type:Organization
Organization Name:FAMILY HOME CARE ALF, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIRENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER/ADMINISTRATOR
Authorized Official - Phone:813-965-5394
Mailing Address - Street 1:6214 N THATCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-4837
Mailing Address - Country:US
Mailing Address - Phone:813-965-5394
Mailing Address - Fax:813-443-6894
Practice Address - Street 1:6214 N THATCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4837
Practice Address - Country:US
Practice Address - Phone:813-965-5394
Practice Address - Fax:813-443-6894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility