Provider Demographics
NPI:1326517053
Name:FAMILY EXTENDED CARE OF CENTRAL TAMPA, INC.
Entity Type:Organization
Organization Name:FAMILY EXTENDED CARE OF CENTRAL TAMPA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-325-1080
Mailing Address - Street 1:5010 N 40TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-5202
Mailing Address - Country:US
Mailing Address - Phone:813-663-9696
Mailing Address - Fax:
Practice Address - Street 1:5010 N 40TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-5202
Practice Address - Country:US
Practice Address - Phone:813-663-9696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility