Provider Demographics
NPI:1932520004
Name:NUEVA VIDA ALF II INC
Entity Type:Organization
Organization Name:NUEVA VIDA ALF II INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYZA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-766-2376
Mailing Address - Street 1:2827 MAX SMITH RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559
Mailing Address - Country:US
Mailing Address - Phone:813-766-2376
Mailing Address - Fax:813-388-9782
Practice Address - Street 1:2827 MAX SMITH RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559
Practice Address - Country:US
Practice Address - Phone:813-766-2376
Practice Address - Fax:813-388-9782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12442385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care