Provider Demographics
NPI:1942087275
Name:TAMPA ROAD OPCO LLC
Entity Type:Organization
Organization Name:TAMPA ROAD OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AMITAI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-855-4661
Mailing Address - Street 1:3865 TAMPA RD
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3865 TAMPA RD
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3008
Practice Address - Country:US
Practice Address - Phone:813-855-4661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility