Provider Demographics
NPI:1770261331
Name:TAMPA THA OPCO, LLC
Entity type:Organization
Organization Name:TAMPA THA OPCO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ARI
Authorized Official - Last Name:LOREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-687-7961
Mailing Address - Street 1:3845 CARPENTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-5204
Mailing Address - Country:US
Mailing Address - Phone:917-687-7961
Mailing Address - Fax:646-496-9182
Practice Address - Street 1:1203 E 22ND AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-1719
Practice Address - Country:US
Practice Address - Phone:813-229-6901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility