Organization
GENESIS ALF OF TAMPA MANAGEMENT GROUP CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLADYS KANODEREKA (ADMINISTRATOR)
(813) 330-8424
Entity
Organization
Contact information
Practice address
1108 BLACK KNIGHT DR, VALRICO, FL 33594-5800
(813) 530-0909
Mailing address
1108 BLACK KNIGHT DR, VALRICO, FL 33594-5800
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL12747
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AL12747
LICENSE NUMBER
FL
Enumeration date
08/23/2018
Last updated
08/23/2018
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