Provider Demographics
NPI:1588715056
Name:ALBANY AVENUE ADULT CONGREGATE LIVING FACILITY, INC.
Entity type:Organization
Organization Name:ALBANY AVENUE ADULT CONGREGATE LIVING FACILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:LUE
Authorized Official - Last Name:MANESCALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-253-0034
Mailing Address - Street 1:211 N ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1502
Mailing Address - Country:US
Mailing Address - Phone:813-253-0034
Mailing Address - Fax:813-258-3400
Practice Address - Street 1:211 N ALBANY AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1502
Practice Address - Country:US
Practice Address - Phone:813-253-0034
Practice Address - Fax:813-258-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL6044310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility