1093802357 NPI number — ROCKY CREEK RETIREMENT PROPERTIES, INC.

Table of content: DR. JOHN MAURICE BYRNE (NPI 1700805504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093802357 NPI number — ROCKY CREEK RETIREMENT PROPERTIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKY CREEK RETIREMENT PROPERTIES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093802357
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8606 BOULDER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33615-1414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-884-3388
Provider Business Mailing Address Fax Number:
813-882-4228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8606 BOULDER CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33615-1414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-884-3388
Provider Business Practice Location Address Fax Number:
813-882-4228
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WINGO
Authorized Official First Name:
TOM
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
813-884-3388

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  21903096 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 650686100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 650686101 . This is a "MEDWAIVER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com