MEDICARE: EXTENDED CARE PORTFOLIO 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
1	310400000X	Assisted Living Facility	AL99	FL

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	:	1912330424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXTENDED CARE PORTFOLIO TENANT, LLC

Provider Business Mailing Address
First Line	:	13770 58TH ST N
Second Line	:	SUITE 312
City	:	CLEARWATER
State	:	FL
Zip	:	33760-3759
Country	:	US
Telephone Number	:	727-726-3980
Fax Number	:

Provider Business Practice Location Address
First Line	:	3207 N MONROE ST
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-2832
Country	:	US
Telephone Number	:	850-562-4123
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	TERESA EDWARDS
Credential	:
Telephone Number	:	727-726-3980

Provider Enumeration Date	:	08/20/2013
Last Update Date	:	08/20/2013

Similar Medicare Providers

1619756483 — NORTHSTAR SENIOR LIVING, INC.
Practice Location Address:

3207 N MONROE ST
TALLAHASSEE, FL
32303-2832

Practice Phone: 850-562-4123
Practice Fax:

1104787670 — LORI VANDEKERCKHOVE
Practice Location Address:

3207 N MONROE ST
TALLAHASSEE, FL
32303-2832

Practice Phone: 850-562-4123
Practice Fax: 850-562-5895

1609729268 — BETHANY LIFE LLC
Practice Location Address:

3380 SAWTOOTH DR
TALLAHASSEE, FL
32303-7368

Practice Phone: 850-999-9695
Practice Fax:

1912859265 — CORNERSTONE CAREGIVING EAST LLC
Practice Location Address:

3101 SESSION RD STE 115
TALLAHASSEE, FL
32303-2874

Practice Phone: 448-210-1044
Practice Fax:

1467304527 — ATLANTIC CARE HOME HEALTH TALLAHASSEE LLC
Practice Location Address:

1309 THOMASVILLE RD STE 326
TALLAHASSEE, FL
32303-5792

Practice Phone: 407-270-5501
Practice Fax:

1902758956 — LATAERIA GIBSON
Practice Location Address:

220 JOHN KNOX RD STE 2
TALLAHASSEE, FL
32303-6631

Practice Phone: 850-597-0370
Practice Fax:

Directions to “EXTENDED CARE PORTFOLIO TENANT, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.