Provider Demographics
NPI:1134735350
Name:ZACH ADULT FAMILY CARE HOME
Entity type:Organization
Organization Name:ZACH ADULT FAMILY CARE HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZACHEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MERISIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-732-2350
Mailing Address - Street 1:3220 LINDELL AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-7862
Mailing Address - Country:US
Mailing Address - Phone:813-732-2350
Mailing Address - Fax:
Practice Address - Street 1:3220 LINDELL AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-7862
Practice Address - Country:US
Practice Address - Phone:813-732-2350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103950800Medicaid
FL103950800Medicaid