Organization
DIVINE GALLO HOUSE ALF, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHIT VIJAPURA M.D. (PRESIDENT)
(813) 966-5646
Entity
Organization
Contact information
Practice address
9110 STAR TRL, NEW PORT RICHEY, FL 34654-2542
(727) 378-8065
(727) 378-8249
Mailing address
1911 W DR MARTIN LUTHER KING JR BLVD, TAMPA, FL 33607-6509
(646) 673-0044
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
11932639
FL
Other
Enumeration date
06/19/2016
Last updated
06/19/2016
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