1386944064 NPI number — ALCOVE RETIREMENT CENTER III

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386944064 NPI number — ALCOVE RETIREMENT CENTER III

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALCOVE RETIREMENT CENTER III
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALCOVE ASSISTED LIVING FACILITY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386944064
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2801 4TH ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-898-0560
Provider Business Mailing Address Fax Number:
727-895-1155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 4TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-898-0560
Provider Business Practice Location Address Fax Number:
727-895-1155
Provider Enumeration Date:
10/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MCNULTY
Authorized Official First Name:
NELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
727-898-0560

Provider Taxonomy Codes

  • Taxonomy code: 3104A0625X , with the licence number:  AL6511 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 140082700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 685933000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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