Organization
SA PG-TAMPA LLC
Active
Other names
Palm Garden of Tampa
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALEX PALEY (COO)
(914) 390-4363
Entity
Organization
Contact information
Practice address
3612 E 138TH AVE, TAMPA, FL 33613-4703
(813) 972-8775
(813) 978-0680
Mailing address
3612 E 138TH AVE, TAMPA, FL 33613-4703
(813) 972-8775
(813) 978-0680
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF1420095
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025752400
—
FL
Enumeration date
06/22/2005
Last updated
07/22/2008
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