Provider Demographics
NPI:1699164228
Name:ANGELS SENIOR LIVING AT NEW TAMPA
Entity type:Organization
Organization Name:ANGELS SENIOR LIVING AT NEW TAMPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:813-632-6370
Mailing Address - Street 1:14712 N 42ND ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-2955
Mailing Address - Country:US
Mailing Address - Phone:813-632-6370
Mailing Address - Fax:
Practice Address - Street 1:14712 N 42ND ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2955
Practice Address - Country:US
Practice Address - Phone:813-632-6370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12507310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility