GENESIS ALF OF TAMPA MANAGEMENT GROUP CORP NPI 1417438854

NPI Information

NPI: 1417438854
Provider Name: GENESIS ALF OF TAMPA MANAGEMENT GROUP CORP
Classification: Assisted Living Facility - 310400000X
Entity Type: Organization
Address:
1108 BLACK KNIGHT DR
VALRICO, FL
ZIP 33594
Phone: (813) 530-0909
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GENESIS ALF OF TAMPA MANAGEMENT GROUP CORP is an assisted living facility in Valrico, FL. The provider is 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. GENESIS ALF OF TAMPA MANAGEMENT GROUP CORP NPI is 1417438854. The provider is registered as an organization entity type.

The provider's business location address is:

1108 BLACK KNIGHT DR
VALRICO, FL
ZIP 33594-800
Phone: (813) 530-0909

The provider's authorized official is Gladys Kanodereka .
The authorized official title is Administrator and has the following contact phone number (813) 330-8424.

The enumeration date for this NPI number is 8/23/2018 and was last updated on 8/23/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility		AL12747	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	AL12747	OTHER	FLORIDA	LICENSE NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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