Provider Demographics
NPI:1669561098
Name:TR & SNF INC
Entity type:Organization
Organization Name:TR & SNF INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SONDRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CORNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-972-8006
Mailing Address - Street 1:12250 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4955
Mailing Address - Country:US
Mailing Address - Phone:813-972-8006
Mailing Address - Fax:813-972-8081
Practice Address - Street 1:12250 N 22ND ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4955
Practice Address - Country:US
Practice Address - Phone:813-972-8006
Practice Address - Fax:813-972-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF15690961314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025946200Medicaid
5119180001Medicare NSC
FL105677Medicare ID - Type UnspecifiedPROVIDER NIMBER