Provider Demographics
NPI:1396559670
Name:ELENIA'S ELYSIAN ENCLAVE ALF LLC
Entity type:Organization
Organization Name:ELENIA'S ELYSIAN ENCLAVE ALF LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMID
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-993-6992
Mailing Address - Street 1:6916 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-1102
Mailing Address - Country:US
Mailing Address - Phone:813-393-3978
Mailing Address - Fax:
Practice Address - Street 1:6919 N 30TH STREET
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610
Practice Address - Country:US
Practice Address - Phone:813-993-6992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility