MEDICARE: TERRA BELLA ONE, 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	:	1841826997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRA BELLA ONE, LLC

Provider Business Mailing Address
First Line	:	2200 LIVINGSTON RD
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-3416
Country	:	US
Telephone Number	:	813-388-2121
Fax Number	:	813-388-2138

Provider Business Practice Location Address
First Line	:	2200 LIVINGSTON RD
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-3416
Country	:	US
Telephone Number	:	813-388-2121
Fax Number	:	813-388-2138

Authorized Official
Title or Position	:	DIRECTOR OF HEALTH AND WELLNESS
Name	:	HEATHER HAWKINS
Credential	:	LPN
Telephone Number	:	813-388-2121

Provider Enumeration Date	:	03/20/2020
Last Update Date	:	03/20/2020

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