MEDICARE: TAMPA BAY GROUP HOMES, 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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1578172805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA BAY GROUP HOMES, INC

Provider Business Mailing Address
First Line	:	18801 N DALE MABRY HWY # 114
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33548-4980
Country	:	US
Telephone Number	:	727-514-1307
Fax Number	:	727-451-0243

Provider Business Practice Location Address
First Line	:	1224 7TH ST S
Second Line	:
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-4101
Country	:	US
Telephone Number	:	727-451-0242
Fax Number	:	727-451-0243

Authorized Official
Title or Position	:	FINANCIAL MANAGER
Name	:	SHARON RYAN
Credential	:
Telephone Number	:	727-514-1307

Provider Enumeration Date	:	07/22/2020
Last Update Date	:	07/22/2020

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