Provider Demographics
NPI:1982036125
Name:CORRIGAN PLACE, ALF, INC.
Entity Type:Organization
Organization Name:CORRIGAN PLACE, ALF, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:VARDELEON
Authorized Official - Last Name:GUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-410-7966
Mailing Address - Street 1:11420 CORRIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-4706
Mailing Address - Country:US
Mailing Address - Phone:727-410-7966
Mailing Address - Fax:352-200-5222
Practice Address - Street 1:11420 CORRIGAN ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-4706
Practice Address - Country:US
Practice Address - Phone:727-410-7966
Practice Address - Fax:352-200-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11814310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility