Provider Demographics
NPI:1467874008
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:GREYSTONE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:F
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-635-9500
Mailing Address - Street 1:5421 BEAUMONT CENTER BLVD.
Mailing Address - Street 2:SUITE 680
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634
Mailing Address - Country:US
Mailing Address - Phone:813-814-4025
Mailing Address - Fax:813-855-9704
Practice Address - Street 1:5421 BEAUMONT CENTER BLVD STE 680
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5294
Practice Address - Country:US
Practice Address - Phone:813-814-4025
Practice Address - Fax:813-855-9704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992484251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299992484Other299992484-AHCA LICENSE NUMBER