MEDICARE: HANNA OAKS OPERATING LLC

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	310400000X	Assisted Living Facility	61	FL

General Provider Information

NPI Number	:	1467994764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANNA OAKS OPERATING LLC

Provider Business Mailing Address
First Line	:	2425 E HANNA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-1317
Country	:	US
Telephone Number	:	813-238-3053
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 E HANNA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-1317
Country	:	US
Telephone Number	:	813-238-3053
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. HILLEL FEUERMAN
Credential	:
Telephone Number	:	718-793-0950

Provider Enumeration Date	:	11/17/2016
Last Update Date	:	11/17/2016

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