Organization · NPI-2

16001 Lakeshore Villa Drive Opco LLC

Assisted Living Facility · Tampa, FL

NPI number1699643528
StatusActive
Last updated in NPPESOct 23, 2025

Details

NPI
1699643528
Entity type
Organization (NPI-2)
Legal business name
16001 Lakeshore Villa Drive Opco LLC
Organization subpart
No
Enumeration date
Oct 23, 2025
Certification date
Oct 23, 2025
Last updated
Oct 23, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
310400000X Assisted Living Facility––Yes

Practice location

16001 Lakeshore Villa Dr
Tampa, FL 33613-1336

Phone 813-386-1145

Mailing address

4500 Dorr St
Toledo, OH 43615-4040

Phone 419-247-2800

Authorized official

Russell Simon
Authorized Official
4192472800

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