Healthcare Provider Details

I. General information

NPI: 1043940950
Provider Name (Legal Business Name): HSE-AHR ST PETERSBURG TRS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 66TH STREET N
ST PETERSBURG FL
33710
US

IV. Provider business mailing address

1101 66TH STREET NORTH
ST PETERSBURG FL
33710
US

V. Phone/Fax

Practice location:
  • Phone: 727-513-8830
  • Fax: 727-683-9503
Mailing address:
  • Phone: 727-513-8830
  • Fax: 727-683-9503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: EUGENE VALENTINE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 727-336-9940