Provider Demographics
NPI:1619380383
Name:MURRAY MANOR OF TAMPA, INC
Entity Type:Organization
Organization Name:MURRAY MANOR OF TAMPA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTATOR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:INNISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-984-7766
Mailing Address - Street 1:13106 N 53RD ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1210
Mailing Address - Country:US
Mailing Address - Phone:813-984-7766
Mailing Address - Fax:
Practice Address - Street 1:13106 N 53RD ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-1210
Practice Address - Country:US
Practice Address - Phone:813-984-7766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9397310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility