Provider Demographics
NPI:1316353402
Name:AMERICAN WELL CARE LLC
Entity type:Organization
Organization Name:AMERICAN WELL CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSABBAGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-924-1704
Mailing Address - Street 1:8370 W HILLSBOROUGH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3815
Mailing Address - Country:US
Mailing Address - Phone:813-924-1704
Mailing Address - Fax:813-889-0788
Practice Address - Street 1:6333 LANGSTON AVE
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-1014
Practice Address - Country:US
Practice Address - Phone:727-846-8487
Practice Address - Fax:727-846-8516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10549310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility