Provider Demographics
NPI:1740706787
Name:NUEVO AMANECER TAMPA, LLC
Entity type:Organization
Organization Name:NUEVO AMANECER TAMPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMACHO-BARRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-785-1732
Mailing Address - Street 1:7405 ARIPEKA DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-4703
Mailing Address - Country:US
Mailing Address - Phone:813-785-1732
Mailing Address - Fax:
Practice Address - Street 1:7405 ARIPEKA DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619
Practice Address - Country:US
Practice Address - Phone:813-785-1732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13034310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility