Organization
EL PALMAR LLC
Active
Other names
Mis Abuelos ALF 2
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAGOBERTO MEDINA (OWNER)
(813) 784-0328
Entity
Organization
Contact information
Practice address
3406 W CARACAS ST, TAMPA, FL 33614-6604
(813) 784-0328
(813) 405-8012
Mailing address
3406 W CARACAS ST, TAMPA, FL 33614-6604
(813) 784-0328
(813) 405-8012
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
AL12080
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AL12080
AHCA LICENSE
FL
Enumeration date
01/22/2014
Last updated
01/22/2014
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