Provider Demographics
NPI:1578975033
Name:BELVEDERE COMMONS OF TAMPA
Entity Type:Organization
Organization Name:BELVEDERE COMMONS OF TAMPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUTH ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RISTOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-265-0844
Mailing Address - Street 1:1513 W FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-3315
Mailing Address - Country:US
Mailing Address - Phone:813-265-0844
Mailing Address - Fax:813-265-1446
Practice Address - Street 1:1513 W FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3315
Practice Address - Country:US
Practice Address - Phone:813-265-0844
Practice Address - Fax:813-265-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8803311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)