Organization Name: | GOMES PLACE LLC |
NPI Number: | 1780070078 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | EDDY T OGBEKHILU (ADMINISTRATOR) |
Mailing Address: | 17607 Simmons Rd Lutz |
State: | FL US |
Postal Code: | 335484596 |
Phone Number: | 8135061432 |
Fax Number: | 8139097390 |
NPI Enumeration Date: | 04/13/2015 |
NPI Last Update Date: | 04/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 310400000X |
License Number: | AL 12621 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Nursing & Custodial Care Facilities |
Taxonomy Classification: | Assisted Living Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |