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Organization

IMPERIAL LIVNG INC

Active
Other names
Imperial Livng Inc
Organization subpart
No

Provider details

NPI number
Authorized official
MS. NISA N CARABALLO (COO)
(727) 512-8465
Entity
Organization

Contact information

Practice address
2820 39TH AVE N, ST PETERSBURG, FL 33714-4524
(727) 657-5767
Mailing address
2820 39TH AVE N, ST PETERSBURG, FL 33714-4524
(727) 657-5767

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
251S00000X
Community/Behavioral Health Agency
253Z00000X
In Home Supportive Care Agency

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100285000
FL
Enumeration date
01/30/2020
Last updated
01/30/2020
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