Provider Demographics
NPI:1063950087
Name:ABUELO FELIZ HOME LLC
Entity type:Organization
Organization Name:ABUELO FELIZ HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:LIDIA
Authorized Official - Last Name:MOLANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-495-3660
Mailing Address - Street 1:8625 MAY CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1733
Mailing Address - Country:US
Mailing Address - Phone:813-495-3660
Mailing Address - Fax:
Practice Address - Street 1:8625 MAY CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1733
Practice Address - Country:US
Practice Address - Phone:813-495-3660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12964310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility