Provider Demographics
NPI:1578172805
Name:TAMPA BAY GROUP HOMES, INC
Entity Type:Organization
Organization Name:TAMPA BAY GROUP HOMES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-514-1307
Mailing Address - Street 1:18801 N DALE MABRY HWY # 114
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-4980
Mailing Address - Country:US
Mailing Address - Phone:727-514-1307
Mailing Address - Fax:727-451-0243
Practice Address - Street 1:1224 7TH ST S
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-4101
Practice Address - Country:US
Practice Address - Phone:727-451-0242
Practice Address - Fax:727-451-0243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services