Healthcare Provider Details

I. General information

NPI: 1821006701
Provider Name (Legal Business Name): SENIOR CARE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16002 LAKESHORE VILLA DR
TAMPA FL
33613-1367
US

IV. Provider business mailing address

16002 LAKESHORE VILLA DR
TAMPA FL
33613-1367
US

V. Phone/Fax

Practice location:
  • Phone: 813-968-5093
  • Fax: 813-264-0476
Mailing address:
  • Phone: 813-968-5093
  • Fax: 813-264-0476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1282096
License Number StateFL

VIII. Authorized Official

Name: MR. RONALD MILLINER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 813-968-5093