Provider Demographics
NPI:1366524613
Name:ROCKY CREEK RETIREMENT PROPERTIES, INC.
Entity type:Organization
Organization Name:ROCKY CREEK RETIREMENT PROPERTIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:WINGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-884-3388
Mailing Address - Street 1:8606 BOULDER CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1414
Mailing Address - Country:US
Mailing Address - Phone:813-884-3388
Mailing Address - Fax:813-882-4228
Practice Address - Street 1:8606 BOULDER CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1414
Practice Address - Country:US
Practice Address - Phone:813-884-3388
Practice Address - Fax:813-882-4228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPT686663261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686663Medicare ID - Type Unspecified