Provider Demographics
NPI:1669739835
Name:ADKINSON ASSISTED LIVING FACILITIES, LLC
Entity type:Organization
Organization Name:ADKINSON ASSISTED LIVING FACILITIES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:GLORIA
Authorized Official - Last Name:ADKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:727-344-1839
Mailing Address - Street 1:6021 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8512
Mailing Address - Country:US
Mailing Address - Phone:727-344-1839
Mailing Address - Fax:727-344-1839
Practice Address - Street 1:284 CYPRESS TRCE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34688-8523
Practice Address - Country:US
Practice Address - Phone:727-510-7521
Practice Address - Fax:727-344-1839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10013310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004140800Medicaid