Organization
SILVER LAKE ALF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASRIEL LOPEZ (ADMINISTRATOR)
(813) 410-0828
Entity
Organization
Contact information
Practice address
3211 W SITKA ST, TAMPA, FL 33614-2701
(813) 410-0828
(813) 999-4036
Mailing address
3211 W SITKA ST, TAMPA, FL 33614-2701
(813) 410-0828
(813) 999-4036
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL11512
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009213400
—
FL
Enumeration date
03/08/2017
Last updated
03/08/2017
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