Provider Demographics
NPI:1528414356
Name:NOVUM TAMPA SNF, LLC
Entity Type:Organization
Organization Name:NOVUM TAMPA SNF, LLC
Other - Org Name:THE NURSING CENTER AT UNIVERSITY VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:KLINOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-319-4427
Mailing Address - Street 1:3152 LITTLE RD
Mailing Address - Street 2:SUITE 146
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1864
Mailing Address - Country:US
Mailing Address - Phone:813-920-3133
Mailing Address - Fax:
Practice Address - Street 1:12250 N 22ND ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4955
Practice Address - Country:US
Practice Address - Phone:813-972-8001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility