Provider Demographics
NPI:1043634876
Name:JUSTIN FAMILY A.L.F. LLC
Entity type:Organization
Organization Name:JUSTIN FAMILY A.L.F. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-735-3600
Mailing Address - Street 1:10103 BAY WIND CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2634
Mailing Address - Country:US
Mailing Address - Phone:813-735-3600
Mailing Address - Fax:813-405-4149
Practice Address - Street 1:10103 BAY WIND CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2634
Practice Address - Country:US
Practice Address - Phone:813-735-3600
Practice Address - Fax:813-405-4149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11790320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness