Provider Demographics
NPI:1013329317
Name:TOUCHED BY FAITH TAMPA, LLC
Entity Type:Organization
Organization Name:TOUCHED BY FAITH TAMPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-202-8932
Mailing Address - Street 1:1239 4TH ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-5223
Mailing Address - Country:US
Mailing Address - Phone:727-202-8932
Mailing Address - Fax:727-202-8933
Practice Address - Street 1:4008 E MILLER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-7418
Practice Address - Country:US
Practice Address - Phone:813-985-3539
Practice Address - Fax:727-202-8933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOUCHED BY FAITH TAMPA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12430310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010334000Medicaid