Provider Demographics
NPI:1881801223
Name:MICHT CORP
Entity type:Organization
Organization Name:MICHT CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MICHELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-221-5114
Mailing Address - Street 1:2907 N BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-1207
Mailing Address - Country:US
Mailing Address - Phone:813-221-5114
Mailing Address - Fax:813-221-4744
Practice Address - Street 1:2907 N BOULEVARD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-1207
Practice Address - Country:US
Practice Address - Phone:813-221-5114
Practice Address - Fax:813-221-4744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility