Provider Demographics
NPI:1356765952
Name:TANGERINE COVE OF BROOKSVILLE BSLC LLC
Entity type:Organization
Organization Name:TANGERINE COVE OF BROOKSVILLE BSLC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-809-6147
Mailing Address - Street 1:307 HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-2039
Mailing Address - Country:US
Mailing Address - Phone:352-796-3276
Mailing Address - Fax:352-754-8584
Practice Address - Street 1:307 HOWELL AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-2039
Practice Address - Country:US
Practice Address - Phone:352-796-3276
Practice Address - Fax:352-754-8584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility