Provider Demographics
NPI:1801154604
Name:CATH E-Z LIVING FACILITY, LLC.
Entity type:Organization
Organization Name:CATH E-Z LIVING FACILITY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHALENE
Authorized Official - Middle Name:SAMS
Authorized Official - Last Name:KINSLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSM
Authorized Official - Phone:813-685-5656
Mailing Address - Street 1:601 OVERLAND DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5940
Mailing Address - Country:US
Mailing Address - Phone:813-653-3945
Mailing Address - Fax:813-689-9817
Practice Address - Street 1:907 PINE RIDGE CIR E
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6277
Practice Address - Country:US
Practice Address - Phone:813-685-5656
Practice Address - Fax:813-685-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12127310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility