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Organization
ELS
Active
Organization
ELS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGINA PENA (ADMINISTRATOR)
(813) 528-7213
Entity
Organization
Contact information
Practice address
12403 OAK CEDAR PL, SUITE 101, TAMPA, FL 33612-4332
(813) 528-7213
Mailing address
12403 OAK CEDAR PL, SUITE 101, TAMPA, FL 33612-4332
(813) 528-7213
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
233889
FL
Other
Enumeration date
04/02/2015
Last updated
04/02/2015
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