Provider Demographics
NPI:1831704980
Name:OCEAN BREEZE ALF LLC
Entity type:Organization
Organization Name:OCEAN BREEZE ALF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAVIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENITEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-417-8203
Mailing Address - Street 1:4713 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-5018
Mailing Address - Country:US
Mailing Address - Phone:813-417-8203
Mailing Address - Fax:813-243-8492
Practice Address - Street 1:4713 KELLY RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-5018
Practice Address - Country:US
Practice Address - Phone:813-417-8203
Practice Address - Fax:813-243-8492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility