Divine Gallo House Alf, LLC

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

11932639 Issued in FL

Legal business name

DIVINE GALLO HOUSE ALF, LLC

Practice address

9110 Star TRL
New Port Richey, FL 34654-2542

Phone

(727) 378-8065

Fax

(727) 378-8249

NPI assigned

Jun 19, 2016

Organization subpart

No

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

Authorized official

Name

Ashit Vijapura, M.D.

Title

President

Phone

(813) 966-5646

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1466294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466294400000",
    "number": "1447600663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1911 W DR MARTIN LUTHER KING JR BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336076509",
            "telephone_number": "646-673-0044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9110 STAR TRL",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346542542",
            "telephone_number": "727-378-8065",
            "fax_number": "727-378-8249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE GALLO HOUSE ALF, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-19",
        "last_updated": "2016-06-19",
        "status": "A",
        "authorized_official_last_name": "VIJAPURA",
        "authorized_official_first_name": "ASHIT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-966-5646",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "FL",
            "license": "11932639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility (Mental Illness) in New Port Richey, FL
• Providers in New Port Richey, FL by specialty
• Assisted Living Facility (Mental Illness) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2016; 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.