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NPI Code Detail

MEDICARE: SENIOR CARE GROUP, INC

MEDICARE: SENIOR CARE GROUP, INC
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
13140N1450XPediatric Skilled Nursing FacilitySNF1282096FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568409746
Entity Type Code : Organization
Provider Name (Legal Business Name) : SENIOR CARE GROUP, INC
Provider Business Mailing Address
First Line : 16002 LAKESHORE VILLA DRIVE
Second Line :
City : TAMPA
State : FL
Zip : 33613-1367
Country : US
Telephone Number : 813-968-5093
Fax Number : 813-264-0476
Provider Business Practice Location Address
First Line : 16002 LAKESHORE VILLA DRIVE
Second Line :
City : TAMPA
State : FL
Zip : 33613-1367
Country : US
Telephone Number : 813-968-5093
Fax Number : 813-264-0476
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : MRS. KATHERINE CHUDOW
Credential :
Telephone Number : 813-341-2735
Provider Enumeration Date : 05/31/2006
Last Update Date : 11/21/2011

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