Provider Demographics
NPI:1235522889
Name:TOBY WEINMAN ASSISTED LIVING RESIDENCE
Entity Type:Organization
Organization Name:TOBY WEINMAN ASSISTED LIVING RESIDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:727-302-3702
Mailing Address - Street 1:255 59TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8539
Mailing Address - Country:US
Mailing Address - Phone:727-345-2775
Mailing Address - Fax:727-345-3957
Practice Address - Street 1:240 59TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710
Practice Address - Country:US
Practice Address - Phone:727-345-2775
Practice Address - Fax:727-345-3957
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENORAH MANOR SENIOR LIVING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-06
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10306310400000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010297800Medicaid