Organization
ILEANA'S CARE HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ILEANA BERMUDEZ (ADMINISTRATOR)
(201) 741-5460
Entity
Organization
Contact information
Practice address
6401 W CLIFTON ST, TAMPA, FL 33634-5010
(201) 741-5460
(813) 559-7301
Mailing address
6401 W CLIFTON ST, TAMPA, FL 33634-5010
(201) 741-5460
(813) 559-7301
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022857600
—
FL
Enumeration date
01/27/2022
Last updated
01/27/2022
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