Provider Demographics
NPI:1255811675
Name:DOROTHY CARES ALF, LLC
Entity type:Organization
Organization Name:DOROTHY CARES ALF, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARAUJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-862-8871
Mailing Address - Street 1:5326 SANDY SHELL DR
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-3503
Mailing Address - Country:US
Mailing Address - Phone:813-862-8871
Mailing Address - Fax:813-443-0301
Practice Address - Street 1:10427 CRESTFIELD DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5774
Practice Address - Country:US
Practice Address - Phone:813-862-8871
Practice Address - Fax:813-443-0301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOROTHY CARES ALF, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL13055310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023530700Medicaid