=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437143906
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENIOR CARE GROUP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2005
-----------------------------------------------------
Last Update Date | 07/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16002 LAKESHORE VILLA DR
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33613-1367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-968-5093
-----------------------------------------------------
Fax | 813-264-0476
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16002 LAKESHORE VILLA DR
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33613-1367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-968-5093
-----------------------------------------------------
Fax | 813-264-0476
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MARK D. KRAMER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-341-2700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | SNF1282096
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------