10D2212069 CLIA NUMBER - BAMBOO VILLAS ASSISTED LIVING FACILITY, LLC

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Laboratory Demographics

CLIA Number: 10D2212069

Facility Name: BAMBOO VILLAS ASSISTED LIVING FACILITY, LLC

Facility Address:
2730 WEST WILDER AVENUE
TAMPA, FL
ZIP 33614
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Facility Phone Number: 813 766-4018

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1114343837

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	10D2212069
LAB Type	Assisted Living Facility
Facility Name	BAMBOO VILLAS ASSISTED LIVING FACILITY, LLC
Street	2730 WEST WILDER AVENUE
City	TAMPA
State	FL
ZIP	33614
Phone	813 766-4018
CertificateType	4
CertificateEffectiveDate	2/2/2023
CertificateExpirationDate	2/1/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024