Provider Profile
HACIENDA ALF SERVICES LLC
Assisted Living Facility
FACILITY PROFILE
Street Address
- 1510 E PALM AVE
TAMPA, FL 33605-3715
County: Hillsborough - Phone: (813) 816-8019
Mailing Address
- 4801 GEORGE ROAD #190
TAMPA, FL 33634
County: Hillsborough - Phone: (813) 816-8019
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Assisted Living in FloridaLong-Term Care
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Facility Information:
| Facility/Provider Type: | Assisted Living Facility | |||||||||
| Administrator: | RAQUEL GONZALEZ | |||||||||
| Financial Officer: | MOSHE EICHLER | |||||||||
| Owner/Licensee: | HACIENDA ALF SERVICES LLC | |||||||||
| Owner/Licensee Since: | 10/15/2022 | |||||||||
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| Profit Status: | Not-For-Profit | |||||||||
| Management Company: | Not Available | |||||||||
| Manager Since: | Not Available | |||||||||
| Licensed Beds: | 36 | |||||||||
| Bed Types: | Extended Congregate Care: 36 Total Capacity: 36 Private: 36 Optional State Supplement: 0 | |||||||||
| AHCA Number (File Number): | 11968096 | |||||||||
| AHCA Field Office: | 06 | |||||||||
| License Number: | 12164 | |||||||||
| Current License Effective: | 10/15/2024 | |||||||||
| Current License Expires: | 10/14/2026 | |||||||||
| License Status: | LICENSED | |||||||||
Services/Characteristics
| Medicaid Services: | Assisted Living Waiver |
| Specialty License: | Extended Congregate Care |
| Activities: | Arts and CraftsExercise ClassesGames/CardsMusic ProgramsSocial Events/OutingsTheater and Movies |
| Bed Hold Policy: | Facility will hold beds during a temporary absence |
| Adult Day Care Services: | Yes |
| Continuing Care Retirement Community: | No |
| Languages Spoken: | EnglishSpanish |
| Nurse Availability: | 3rd Party Part-Time |
| Payment Forms Accepted: | Insurance and/or HMOMedicaidVA |
Emergency Power Plan Summary
| Onsite Alternate Power Source: | Fixed Generator |
| Emergency Power Supports: | Air ConditioningLightsRefrigeration |
| Plan Approval: | 11/7/2017 |
| Implementation Date: | 11/7/2017 |
| Cooling Method: | Air Conditioner |
| Areas Cooled: | Common AreasDining RoomHallway |
| Areas Cooled Location: | Within Facility |
| Square Footage Cooled: | 580 |
| Number of People to use Cooled Space: | 29 |
Legal Actions
| Date Initiated | Case # | Case Type | Violation | Fine Amount | Date Imposed |
|---|---|---|---|---|---|
| 9/7/2023 | 2023013556 | Fine | Survey | $1,500.00 | 2/12/2024 |
| Change of ownership occurred 10/15/2022 | |||||
| 10/6/2022 | 2022015139 | Fine | Survey | $500.00 | 3/6/2023 |
| 7/26/2016 | 2017004742 | Fine | Survey | $8,000.00 | 4/11/2018 |
Important information and facility/provider definitions can be found in the Glossary.
Attn Providers: Requests for changes in data must be sent in writing to the AHCA licensing office.