Provider Demographics
NPI:1720747017
Name:MOMENTS ASSISTED LIVING FACILITY LLC
Entity Type:Organization
Organization Name:MOMENTS ASSISTED LIVING FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DASO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-279-9232
Mailing Address - Street 1:2143 BURNICE DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-4859
Mailing Address - Country:US
Mailing Address - Phone:727-738-5392
Mailing Address - Fax:727-738-5392
Practice Address - Street 1:3240 COUNTY ROAD 1
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-9208
Practice Address - Country:US
Practice Address - Phone:727-738-5392
Practice Address - Fax:727-738-5392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility