Provider Demographics
NPI:1821828450
Name:TAMPA AL OPCO LLC
Entity type:Organization
Organization Name:TAMPA AL OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:AYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-292-1513
Mailing Address - Street 1:460 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11096-1702
Mailing Address - Country:US
Mailing Address - Phone:718-737-6669
Mailing Address - Fax:
Practice Address - Street 1:2425 E HANNA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-1317
Practice Address - Country:US
Practice Address - Phone:718-737-6669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VTAMPA VENTURES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-07
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL125147200Medicaid