Provider Demographics
NPI:1508495409
Name:TWIN DAVIS OPERATOR LLC
Entity Type:Organization
Organization Name:TWIN DAVIS OPERATOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTERPALO
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:732-837-4973
Mailing Address - Street 1:115 E DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3513
Mailing Address - Country:US
Mailing Address - Phone:813-254-8399
Mailing Address - Fax:813-254-6998
Practice Address - Street 1:115 E DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3513
Practice Address - Country:US
Practice Address - Phone:813-254-8399
Practice Address - Fax:813-254-6998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-03
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility