Elderly Pride Assisted Living

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

12869 Issued in FL

Legal business name

ELDERLY PRIDE ASSISTED LIVING

Practice address

322 Regal Park Dr
Valrico, FL 33594-3638

Phone

(520) 822-6822

Fax

(813) 381-4876

NPI assigned

Jul 13, 2016

Organization subpart

No

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

Authorized official

Name

Mr. David A Kadiri

Title

Administrator

Phone

(520) 822-6822

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1468368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468368000000",
    "number": "1518319631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 REGAL PARK DR",
            "city": "VALRICO",
            "state": "FL",
            "postal_code": "335943638",
            "telephone_number": "520-822-6822",
            "fax_number": "813-381-4876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 REGAL PARK DR",
            "city": "VALRICO",
            "state": "FL",
            "postal_code": "335943638",
            "telephone_number": "520-822-6822",
            "fax_number": "813-381-4876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELDERLY PRIDE ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-13",
        "last_updated": "2016-07-13",
        "status": "A",
        "authorized_official_last_name": "KADIRI",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "520-822-6822",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "FL",
            "license": "12869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility (Mental Illness) in Valrico, FL
• Providers in Valrico, 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 Jul 13, 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.