MEDICARE: MICHT CORP

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	310400000X	Assisted Living Facility

Other Identifiers

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

General Provider Information

NPI Number	:	1881801223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHT CORP

Provider Business Mailing Address
First Line	:	2907 N BOULEVARD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-1207
Country	:	US
Telephone Number	:	813-221-5114
Fax Number	:	813-221-4744

Provider Business Practice Location Address
First Line	:	2907 N BOULEVARD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-1207
Country	:	US
Telephone Number	:	813-221-5114
Fax Number	:	813-221-4744

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MISS MICHELINE LYNCEE
Credential	:
Telephone Number	:	813-221-5114

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	08/22/2020

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Directions to “MICHT CORP ” Practice Location

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