MEDICARE: S.A.A.C. GROUP HOME LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1023893419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S.A.A.C. GROUP HOME LLC

Provider Business Mailing Address
First Line	:	18212 SALTWATER RUN PL
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3531
Country	:	US
Telephone Number	:	813-394-9364
Fax Number	:	813-907-5198

Provider Business Practice Location Address
First Line	:	18212 SALTWATER RUN PL
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3531
Country	:	US
Telephone Number	:	813-394-9364
Fax Number	:	813-907-5198

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. TYMARA GIBSON
Credential	:
Telephone Number	:	813-394-9364

Provider Enumeration Date	:	08/25/2023
Last Update Date	:	08/25/2023

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