Basic Information
| Provider Information | |||||||||
| NPI: | 1801068283 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARROLLWOOD ASSISTED LIVING, OPERATIONS, LTD. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HEARTHSTONE AT CARROLLWOOD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2626 W BEARSS AVE | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336181933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139605346 | ||||||||
| FaxNumber: | 8139611458 | ||||||||
| Practice Location | |||||||||
| Address1: | 2626 W BEARSS AVE | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336181933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139605346 | ||||||||
| FaxNumber: | 8139611458 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2008 | ||||||||
| LastUpdateDate: | 03/26/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | VARGAS | ||||||||
| AuthorizedOfficialFirstName: | LIZ | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT/CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 2813623506 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | AL9981 | FL | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.