=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316827991
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENIOR HAVEN DAY CARE CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2025
-----------------------------------------------------
Last Update Date | 09/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2511 W VIRGINIA AVE STE B
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33607-6310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-252-7713
-----------------------------------------------------
Fax | 813-443-0145
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2511 W VIRGINIA AVE STE B
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33607-6310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-252-7713
-----------------------------------------------------
Fax | 813-443-0145
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | ADDRYS ABELLA TORRES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-390-9873
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------