Provider Demographics
NPI:1497169858
Name:NEW TAMPA ASSISTED LIVING COMMUNITY, LLC
Entity Type:Organization
Organization Name:NEW TAMPA ASSISTED LIVING COMMUNITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-545-0682
Mailing Address - Street 1:14712 N 42ND ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-2955
Mailing Address - Country:US
Mailing Address - Phone:813-632-6370
Mailing Address - Fax:
Practice Address - Street 1:14712 N 42ND ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2955
Practice Address - Country:US
Practice Address - Phone:813-632-6370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility