MEDICARE: KAY & JAY 09 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851022644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAY & JAY 09 LLC

Provider Business Mailing Address
First Line	:	1411 E WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-3319
Country	:	US
Telephone Number	:	813-935-8978
Fax Number	:

Provider Business Practice Location Address
First Line	:	1411 E WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-3319
Country	:	US
Telephone Number	:	813-935-8978
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JONALDINE ELISCARD
Credential	:
Telephone Number	:	941-565-9193

Provider Enumeration Date	:	06/22/2022
Last Update Date	:	06/22/2022

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Directions to “KAY & JAY 09 LLC ” Practice Location

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