Provider Demographics
NPI:1972049658
Name:BRISTOL TERRACE MANAGEMENT, LLC
Entity type:Organization
Organization Name:BRISTOL TERRACE MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PREM
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-280-2000
Mailing Address - Street 1:201 N FRANKLIN ST
Mailing Address - Street 2:SUITE 2570
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5182
Mailing Address - Country:US
Mailing Address - Phone:813-280-2000
Mailing Address - Fax:
Practice Address - Street 1:2733 MCCAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-2913
Practice Address - Country:US
Practice Address - Phone:615-889-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility