MEDICARE: ALTAMESE MCQUAY FOUNDATION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1366253320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTAMESE MCQUAY FOUNDATION INC

Provider Business Mailing Address
First Line	:	20125 OUTPOST POINT DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3562
Country	:	US
Telephone Number	:	909-919-4397
Fax Number	:

Provider Business Practice Location Address
First Line	:	3112 E IDA ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-7841
Country	:	US
Telephone Number	:	909-919-4397
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JOHN MITCHELL
Credential	:
Telephone Number	:	909-919-4397

Provider Enumeration Date	:	01/17/2025
Last Update Date	:	01/17/2025

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