MEDICARE: GARDENS OF TIME ADULT DAYCARE CORP

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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1578068615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDENS OF TIME ADULT DAYCARE CORP

Provider Business Mailing Address
First Line	:	7016 N DAKOTA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5328
Country	:	US
Telephone Number	:	813-505-5564
Fax Number	:	813-433-5583

Provider Business Practice Location Address
First Line	:	7016 N DAKOTA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5328
Country	:	US
Telephone Number	:	813-505-5564
Fax Number	:	813-433-5583

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. MARTHA MEDINA
Credential	:
Telephone Number	:	813-505-5564

Provider Enumeration Date	:	03/29/2018
Last Update Date	:	03/29/2018

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