Provider Demographics
NPI:1235551862
Name:GREYSTONE HOME HEALTHCARE OF GREATER TAMPA BAY LLC
Entity Type:Organization
Organization Name:GREYSTONE HOME HEALTHCARE OF GREATER TAMPA BAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:SWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-675-9500
Mailing Address - Street 1:3780 TAMPA RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3041
Mailing Address - Country:US
Mailing Address - Phone:813-814-1343
Mailing Address - Fax:
Practice Address - Street 1:3780 TAMPA RD
Practice Address - Street 2:SUITE 205
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3041
Practice Address - Country:US
Practice Address - Phone:813-814-1343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993666251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299993666Other299993666, AHCA LICENSE NUMBER