Provider Demographics
NPI:1962779819
Name:ALLSHOUSE SUPPORTED LIVING SERVICES
Entity type:Organization
Organization Name:ALLSHOUSE SUPPORTED LIVING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLSHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-538-7772
Mailing Address - Street 1:7738 70TH ST N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-3001
Mailing Address - Country:US
Mailing Address - Phone:727-538-7772
Mailing Address - Fax:727-538-4244
Practice Address - Street 1:7738 70TH ST N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3001
Practice Address - Country:US
Practice Address - Phone:727-538-7772
Practice Address - Fax:727-538-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL001801400251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health