Provider Demographics
NPI:1487123733
Name:PONDELLA RESIDENTIAL CARE LLC
Entity type:Organization
Organization Name:PONDELLA RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADNMISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ILOMISE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALEXANDRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-297-8839
Mailing Address - Street 1:1923 NE 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-2271
Mailing Address - Country:US
Mailing Address - Phone:239-242-0597
Mailing Address - Fax:
Practice Address - Street 1:1923 NE 6TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2271
Practice Address - Country:US
Practice Address - Phone:239-242-0597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PONDELLA SERENITY COURT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility