Provider Demographics
NPI:1053711598
Name:SUPPORT ASSOCIATES OF TAMPA BAY, INC
Entity type:Organization
Organization Name:SUPPORT ASSOCIATES OF TAMPA BAY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEBENEDET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-908-6773
Mailing Address - Street 1:16112 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-6129
Mailing Address - Country:US
Mailing Address - Phone:813-908-6773
Mailing Address - Fax:813-908-0423
Practice Address - Street 1:16112 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-6129
Practice Address - Country:US
Practice Address - Phone:813-908-6773
Practice Address - Fax:813-908-0423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002353400Medicaid
FL678755096Medicaid