NPIMap

Organization Active NPI

Florry Creative Care Corporation

Doing business as Coventry Assisted Living

  • Assisted Living Facility
  • Plant City, FL
National Provider Identifier
1427393289
Registry record updated Jan 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
AL12181 Issued in FL
Legal business name
FLORRY CREATIVE CARE CORPORATION
Doing business as
Coventry Assisted Living
Practice address
415 N. Wilder Rd
Plant City, FL 33566
Phone
(813) 441-4761
Fax
(813) 704-4745
NPI assigned
Dec 5, 2012
Last updated
Jan 9, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
FLORRY CREATIVE CARE CORPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 9, 2020

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

Authorized official

Name
Cherry Hallback
Title
Administrator
Phone
(813) 704-6918

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X AL12181 FL Primary

Addresses

Primary practice location

415 N. Wilder Rd
Plant City, FL 33566

Mailing address

415 N. Wilder Rd
Plant City, FL 33566
Phone (813) 441-4761

Other identifiers 1

IdentifierTypeStateIssuer
104395400MedicaidFL

Other names 1

  • Coventry Assisted Living Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2208579Coventry Assisted Living415 N Wilder Rd, Plant City, FL 33566Certificate of waiverJan 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
Florry Creative Care5 organizations share this tax ID, including this one
Part of
Florry Creative Care

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1354665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578528000000",
    "number": "1427393289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 N. WILDER RD",
            "city": "PLANT CITY",
            "state": "FL",
            "postal_code": "33566",
            "telephone_number": "813-441-4761",
            "fax_number": "813-704-4745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 N. WILDER RD",
            "city": "PLANT CITY",
            "state": "FL",
            "postal_code": "33566",
            "telephone_number": "813-441-4761",
            "fax_number": "813-704-4745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORRY CREATIVE CARE CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FLORRY CREATIVE CARE CORP",
        "enumeration_date": "2012-12-05",
        "last_updated": "2020-01-09",
        "certification_date": "2020-01-09",
        "status": "A",
        "authorized_official_last_name": "HALLBACK",
        "authorized_official_first_name": "CHERRY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "813-704-6918"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL12181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104395400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coventry Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Coventry Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plant City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.