MEDICARE: VOP COLONNADE NORTHDALE, 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

General Provider Information

NPI Number	:	1679405716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VOP COLONNADE NORTHDALE, LLC

Provider Business Mailing Address
First Line	:	3401 W BEARSS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2143
Country	:	US
Telephone Number	:	813-694-4049
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 W BEARSS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2143
Country	:	US
Telephone Number	:	813-694-4049
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTIAN N. CUMMINGS
Credential	:	CUMMINGS
Telephone Number	:	502-357-9000

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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