Healthcare Provider Details

I. General information

NPI: 1962637736
Provider Name (Legal Business Name): SELWYN ST LOUIS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W KENNEDY BLVD STE 328
TAMPA FL
33609-2290
US

IV. Provider business mailing address

4100 W KENNEDY BLVD STE 328
TAMPA FL
33609-2290
US

V. Phone/Fax

Practice location:
  • Phone: 813-609-1390
  • Fax: 813-609-1392
Mailing address:
  • Phone: 813-609-1390
  • Fax: 813-609-1392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number231132
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHESKEL SPITZER
Title or Position: DIRECTOR/CEO
Credential:
Phone: 813-609-1390