Healthcare Provider Details

I. General information

NPI: 1932949633
Provider Name (Legal Business Name): 3 GARDENIAS ADULT DAY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7902 W WATERS AVE STE G
TAMPA FL
33615-1850
US

IV. Provider business mailing address

7902 W WATERS AVE STE G
TAMPA FL
33615-1850
US

V. Phone/Fax

Practice location:
  • Phone: 813-939-5679
  • Fax:
Mailing address:
  • Phone: 813-290-7474
  • Fax: 813-243-8924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARYLEYDIS LOPEZ ALVAREZ
Title or Position: CEO
Credential:
Phone: 813-748-1704