Provider Demographics
NPI:1669716668
Name:TAMPA HOUSING AUTHORITY
Entity type:Organization
Organization Name:TAMPA HOUSING AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CONCEPCION
Authorized Official - Middle Name:T
Authorized Official - Last Name:BRETOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-864-4248
Mailing Address - Street 1:5121 SERENA DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-4032
Mailing Address - Country:US
Mailing Address - Phone:813-988-0033
Mailing Address - Fax:813-984-9881
Practice Address - Street 1:5121 SERENA DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-4032
Practice Address - Country:US
Practice Address - Phone:813-988-0033
Practice Address - Fax:813-984-9881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10256310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL685253000Medicaid
FL141867000Medicaid