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General NPI Number Information
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NPI Number | 1982028601
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Entity Type | Organization
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Legal Business Name | YETEY ENTERPRISES INC DBA SPRINGSWATER ALF
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Dates
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Enumeration Date | 02/17/2014
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Last Update Date | 04/17/2020
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Provider Practice Location Address
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Address Line | 1411 E WATERS AVE
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City | TAMPA
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State | FL
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Zip | 33604
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Country | US
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Telephone | 813-935-8978
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Fax |
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Provider Business Mailing Address
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Address Line | 8602 N 22ND ST
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City | TAMPA
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State | FL
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Zip | 33604-2104
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Country | US
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Telephone | 813-930-8370
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ABIODUN ADEGBOLA
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Credential |
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Telephone | 813-930-8370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | AL10480
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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