Provider Demographics
NPI:1548529225
Name:VILLA LA ESPERANZA III LLC
Entity type:Organization
Organization Name:VILLA LA ESPERANZA III LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEIBY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACINTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-541-0093
Mailing Address - Street 1:8814 SLEEPY CREEK CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1128
Mailing Address - Country:US
Mailing Address - Phone:813-898-8017
Mailing Address - Fax:813-898-8017
Practice Address - Street 1:8814 SLEEPY CREEK CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634
Practice Address - Country:US
Practice Address - Phone:813-333-2980
Practice Address - Fax:813-298-0268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
FLAL12114310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility