Organization
GENESIS ALF OF TAMPA BAY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS GLADYS KANODEREKA (SECRETARY)
(813) 638-5803
Entity
Organization
Contact information
Practice address
714 VILLAGE PL, BRANDON, FL 33511-6240
(813) 638-5803
Mailing address
714 VILLAGE PL, BRANDON, FL 33511-6240
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
02/28/2014
Last updated
02/28/2014
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