Provider Demographics
NPI:1184032567
Name:GRACE HOUSE OF TAMPA
Entity type:Organization
Organization Name:GRACE HOUSE OF TAMPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMASKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-709-1215
Mailing Address - Street 1:13315 ORANGE GROVE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2915
Mailing Address - Country:US
Mailing Address - Phone:727-709-1215
Mailing Address - Fax:
Practice Address - Street 1:13315 ORANGE GROVE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2915
Practice Address - Country:US
Practice Address - Phone:727-709-1215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12472310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility