Provider Demographics
NPI:1720880438
Name:CONCORDIS ALF TAMPA LLC
Entity type:Organization
Organization Name:CONCORDIS ALF TAMPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FALLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-207-7873
Mailing Address - Street 1:3724 JEFFERSON ST STE 317
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6225
Mailing Address - Country:US
Mailing Address - Phone:352-229-3263
Mailing Address - Fax:
Practice Address - Street 1:12110 MORRIS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-1924
Practice Address - Country:US
Practice Address - Phone:813-694-2153
Practice Address - Fax:512-420-9276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL125681400Medicaid