Provider Demographics
NPI:1962637736
Name:SELWYN ST LOUIS INC
Entity type:Organization
Organization Name:SELWYN ST LOUIS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHESKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPITZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-609-1390
Mailing Address - Street 1:4100 W KENNEDY BLVD STE 328
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2290
Mailing Address - Country:US
Mailing Address - Phone:813-609-1390
Mailing Address - Fax:813-609-1392
Practice Address - Street 1:4100 W KENNEDY BLVD STE 328
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2290
Practice Address - Country:US
Practice Address - Phone:813-609-1390
Practice Address - Fax:813-609-1392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 261QD1600X
FL231132253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL119045700Medicaid
FL119946200Medicaid