Provider Demographics
NPI:1154742922
Name:HOLLAND OAKS ALF, LLC
Entity type:Organization
Organization Name:HOLLAND OAKS ALF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELETT
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-857-6400
Mailing Address - Street 1:910 E HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-6081
Mailing Address - Country:US
Mailing Address - Phone:813-972-0516
Mailing Address - Fax:813-972-0517
Practice Address - Street 1:910 E HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-6081
Practice Address - Country:US
Practice Address - Phone:813-972-0516
Practice Address - Fax:813-972-0517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-22
Last Update Date:2013-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11570310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility