Provider Demographics
NPI:1285622209
Name:FAIRWAY OAKS CENTER, LLC
Entity type:Organization
Organization Name:FAIRWAY OAKS CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ALISE
Authorized Official - Last Name:ZIOLKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:813-558-6629
Mailing Address - Street 1:13806 N 46TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4921
Mailing Address - Country:US
Mailing Address - Phone:813-977-4214
Mailing Address - Fax:813-977-4228
Practice Address - Street 1:13806 N 46TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4921
Practice Address - Country:US
Practice Address - Phone:813-977-4214
Practice Address - Fax:813-977-4228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1613096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026069000Medicaid
FL71-00465OtherEVERCARE HH CONNECTION
FLM85OtherBLUE CROSS BLUE SHIELD
FLC105305OtherUNITED AMERICAN
FL026069000Medicaid
FLC105305OtherUNITED AMERICAN