The Ida House Assisted Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

13170 Issued in FL

Legal business name

THE IDA HOUSE ASSISTED LIVING LLC

Practice address

6014 Rosewood Dr
Tampa, FL 33615

Phone

(813) 562-6135

NPI assigned

Oct 17, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kirenia Bacallao Ruiz

Title

President

Phone

(813) 562-6135

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1508198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551830400000",
    "number": "1083125132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6014 ROSEWOOD DR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336153428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6014 ROSEWOOD DR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33615",
            "telephone_number": "813-562-6135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE IDA HOUSE ASSISTED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-17",
        "last_updated": "2019-03-06",
        "status": "A",
        "authorized_official_last_name": "BACALLAO RUIZ",
        "authorized_official_first_name": "KIRENIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-562-6135"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "13170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "024909900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Tampa, FL
• Providers in Tampa, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.