Provider Demographics
NPI:1013312743
Name:GARDENS OF TIME II
Entity Type:Organization
Organization Name:GARDENS OF TIME II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-505-5564
Mailing Address - Street 1:2914 W SLIGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-4212
Mailing Address - Country:US
Mailing Address - Phone:813-513-4492
Mailing Address - Fax:813-513-4492
Practice Address - Street 1:2914 W SLIGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4212
Practice Address - Country:US
Practice Address - Phone:813-513-4492
Practice Address - Fax:813-513-4492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility