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Organization
JOHNNIE B BYRD SR ALZHEIMERS CENTER AND RESEARCH INSTITUTE
Active
Organization
JOHNNIE B BYRD SR ALZHEIMERS CENTER AND RESEARCH INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LILLY HO - PEHLING (CHIEF OPERATING OFFICER)
(813) 866-1610
Entity
Organization
Contact information
Practice address
4001 E FLETCHER AVE, TAMPA, FL 33613-4808
(813) 866-1611
(813) 866-1612
Mailing address
4001 E FLETCHER AVE, TAMPA, FL 33613-4808
(813) 866-1611
(813) 866-1612
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW 7429
FL
2084P0805X
Geriatric Psychiatry Physician
ME31300
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME31300
BALEBAIL ASHOK RAJ, M.D.
FL
01
—
SW 7429
NANCY ANN TETEN, LCSW,CAP
FL
Enumeration date
06/29/2007
Last updated
07/15/2008
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