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General NPI Number Information
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NPI Number | 1093802357
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Entity Type | Organization
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Legal Business Name | ROCKY CREEK RETIREMENT PROPERTIES, INC.
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 01/20/2009
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Provider Practice Location Address
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Address Line | 8606 BOULDER CT
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City | TAMPA
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State | FL
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Zip | 33615-1414
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Country | US
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Telephone | 813-884-3388
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Fax | 813-882-4228
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Provider Business Mailing Address
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Address Line | 8606 BOULDER CT
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City | TAMPA
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State | FL
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Zip | 33615-1414
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Country | US
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Telephone | 813-884-3388
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Fax | 813-882-4228
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Authorized Official
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Title or Position | CFO
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Name | MR. TOM WINGO
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Credential |
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Telephone | 813-884-3388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 21903096
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License Number State | FL
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