MEDICARE: TAMPA THA OPCO 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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1770261331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA THA OPCO LLC

Provider Business Mailing Address
First Line	:	3845 CARPENTER AVENUE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467
Country	:	US
Telephone Number	:	718-798-1100
Fax Number	:	646-496-9182

Provider Business Practice Location Address
First Line	:	1203 E. 22ND AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605
Country	:	US
Telephone Number	:	813-229-6901
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	MIRIAM LOREN
Credential	:
Telephone Number	:	914-844-4836

Provider Enumeration Date	:	07/05/2023
Last Update Date	:	03/10/2026

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Directions to “TAMPA THA OPCO LLC ” Practice Location

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