Provider Demographics
NPI:1578217964
Name:MANIFESTATIONS WORLDWIDE INC
Entity Type:Organization
Organization Name:MANIFESTATIONS WORLDWIDE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RENAE
Authorized Official - Middle Name:HEYWARD
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:813-900-7941
Mailing Address - Street 1:3102 E LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-7853
Mailing Address - Country:US
Mailing Address - Phone:813-241-6919
Mailing Address - Fax:813-200-1313
Practice Address - Street 1:3610 N 31ST ST # A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-1400
Practice Address - Country:US
Practice Address - Phone:813-900-7941
Practice Address - Fax:813-533-6729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility