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NPI Code Detail

MEDICARE: 2960 TAMPA RD TENANT LLC

MEDICARE: 2960 TAMPA RD TENANT 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
1311500000XAlzheimer Center (Dementia Center)
2310400000XAssisted Living Facility

General Provider Information

NPI Number : 1760210777
Entity Type Code : Organization
Provider Name (Legal Business Name) : 2960 TAMPA RD TENANT LLC
Provider Business Mailing Address
First Line : 8415 E 21ST ST N STE 100
Second Line :
City : WICHITA
State : KS
Zip : 67206-2959
Country : US
Telephone Number : 316-616-6288
Fax Number :
Provider Business Practice Location Address
First Line : 2960 TAMPA RD
Second Line :
City : PALM HARBOR
State : FL
Zip : 34684-3340
Country : US
Telephone Number : 727-781-8686
Fax Number :
Authorized Official
Title or Position : AUTHORIZED REPRESENTATIVE
Name : SHARON MAKOWSKY
Credential :
Telephone Number : 419-247-2800
Provider Enumeration Date : 07/22/2024
Last Update Date : 07/22/2024

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