Organization
FAIRWAY OAKS CENTER, LLC
Active
Other names
Fairway Oaks Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER ALISE ZIOLKOWSKI MBA (VP FINANCE)
(813) 558-6629
Entity
Organization
Contact information
Practice address
13806 N 46TH ST, TAMPA, FL 33613-4921
(813) 977-4214
(813) 977-4228
Mailing address
13806 N 46TH ST, TAMPA, FL 33613-4921
(813) 977-4214
(813) 977-4228
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF1613096
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026069000
—
FL
01
—
71-00465
EVERCARE HH CONNECTION
FL
01
—
C105305
UNITED AMERICAN
FL
01
—
M85
BLUE CROSS BLUE SHIELD
FL
Enumeration date
10/13/2005
Last updated
06/12/2024
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