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Organization

EL PALMAR LLC

Active
Other names
Mis Abuelos ALF 2
Organization subpart
No

Provider details

NPI number
Authorized official
MR. DAGOBERTO MEDINA (MANAGER)
(813) 784-0328
Entity
Organization

Contact information

Practice address
3406 W CARACAS ST, TAMPA, FL 33614
(813) 784-0328
(813) 405-8012
Mailing address
3406 W CARACAS ST, TAMPA, FL 33614-6604
(813) 405-8012
(813) 405-8012

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL12080
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
AL12080
ASSISTED LIVING FACILITY LICENSE. AHCA
FL
Enumeration date
06/16/2011
Last updated
06/20/2018
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