Organization
CONSUELO'S ALF INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MASSIEL REYNALDO PAJAN (ADMINISTRATOR)
(813) 775-8689
Entity
Organization
Contact information
Practice address
4401 W BALLAST POINT BLVD, TAMPA, FL 33611-5601
(813) 775-8689
(813) 839-7495
Mailing address
4401 WEST BALLAST POINT BLVD, TAMPA, FL 33611
(813) 775-8689
(813) 839-7495
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
AL12485
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012871100
—
FL
Enumeration date
12/22/2015
Last updated
12/22/2015
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