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NPI Code Detail

MEDICARE: BLC TAMPA-GC,LLC

MEDICARE: BLC TAMPA-GC,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
1310400000XAssisted Living Facility

General Provider Information

NPI Number : 1578865903
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLC TAMPA-GC,LLC
Provider Business Mailing Address
First Line : 4902 BAYSHORE BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33611-3870
Country : US
Telephone Number : 813-835-4475
Fax Number :
Provider Business Practice Location Address
First Line : 4902 BAYSHORE BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33611-3870
Country : US
Telephone Number : 813-835-4475
Fax Number : 813-831-1382
Authorized Official
Title or Position : ASSISTANT SECRETARY
Name : ANNA F.C. MUNOZ
Credential :
Telephone Number : 414-918-5443
Provider Enumeration Date : 11/17/2010
Last Update Date : 03/20/2025

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Directions to “BLC TAMPA-GC,LLC ” Practice Location

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