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NPI Code Detail

MEDICARE: 2916 HABANA WAY OPERATIONS LLC

MEDICARE: 2916 HABANA WAY OPERATIONS 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
1314000000XSkilled Nursing FacilitySNF15500962FL

Other Identifiers

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

General Provider Information

NPI Number : 1932478674
Entity Type Code : Organization
Provider Name (Legal Business Name) : 2916 HABANA WAY OPERATIONS LLC
Provider Business Mailing Address
First Line : 2916 HABANA WAY
Second Line :
City : TAMPA
State : FL
Zip : 33614-7108
Country : US
Telephone Number : 813-876-5141
Fax Number : 813-876-5233
Provider Business Practice Location Address
First Line : 2916 HABANA WAY
Second Line :
City : TAMPA
State : FL
Zip : 33614-7108
Country : US
Telephone Number : 813-876-5141
Fax Number : 813-876-5233
Authorized Official
Title or Position : VP
Name : KENNETH USSERY JR.
Credential :
Telephone Number : 407-571-1550
Provider Enumeration Date : 12/27/2011
Last Update Date : 11/27/2023

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