Sa-PG Tampa, LLC D/B/a Palm Garden of Tampa

Primary specialty

Pediatric Skilled Nursing FacilityTaxonomy code 3140N1450X

License

SNF13770961 Issued in FL

Legal business name

SA-PG TAMPA, LLC D/B/A PALM GARDEN OF TAMPA

Practice address

3612 E 138TH Ave
Tampa, FL 33613-4703

Phone

(813) 972-8775

Fax

(813) 978-0680

NPI assigned

Jun 27, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Scott J Allen, NHA

Title

Administrator

Phone

(813) 972-8775

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285630954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3612 E 138TH AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336134703",
            "telephone_number": "813-972-8775",
            "fax_number": "813-978-0680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3612 E 138TH AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336134703",
            "telephone_number": "813-972-8775",
            "fax_number": "813-978-0680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SA-PG TAMPA, LLC D/B/A PALM GARDEN OF TAMPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "813-972-8775",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NHA"
    },
    "taxonomies": [
        {
            "code": "3140N1450X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
            "state": "FL",
            "license": "SNF13770961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Skilled Nursing Facility in Tampa, FL
• Providers in Tampa, FL by specialty
• Pediatric Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.