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12250 N 22ND ST
TAMPA, FL 33612-4955
Phone: (813) 972-8001
County: Hillsborough

Mailing Address

12250 N 22ND ST
TAMPA, FL 33612-4955
County: Hillsborough

Emergency Actions:

None
Facility/Provider Type: Nursing Home
Administrator: DORENDA TIGGS
Financial Officer: SAMUEL G. SANDERS
Owner/Licensee: TR & SNF, INC.
Owner/Licensee Since: 10/16/2002
NamePositionOwnership
CHARLES RUMER TATEBOARD MEMBER/OFFICER0%
MARY LOU MOOREBOARD MEMBER/OFFICER0%
RONALD RAY MOOREBOARD MEMBER/OFFICER0%
Profit Status: Not-For-Profit
Licensed Beds: 120
Bed Types:
Community Beds : 0
Sheltered Beds : 120
Pediatric Beds : 0
Private Rooms : 6
2-Bed Rooms : 57
3-Bed Rooms : 0
4-Bed Rooms : 0
AHCA Number (File Number): 62934
AHCA Field Office: 06
License Number: 15690961
Current License Effective: 4/24/2015
Expires: 10/15/2015
License Status: IN LITIGATION

Compare Quality and/or Pricing:

Services/Characteristics:

Current Daily Rate ($) of Semi-Private Room :  $215.00
Occupancy/Occupancy Rate :  0 / 0%
Continuing Care Retirement Community :  Yes
Adult Day Care Services :  No
Languages Spoken :  Creole, Spanish
Payment Forms Accepted :  Insurance and/or HMO, Medicaid, Medicare
Special Programs and Services :  Respite

Emergency Power Plan Summary:

Onsite Alternate Power Source :  Fixed Generator, Portable Generator
Emergency Power Supports :  Life Safety Systems, Lights, ELEVATORS & EMERGENCY OUTLETS, Refrigeration
Plan Approval :  Apr 26, 2018
Implementation Date :  Jun 01, 2018
Cooling Method :  Fans, PORTABLE AIR CONDITIONERS
Areas Cooled :  Dining Room, 1C ACTIVITIES ROOM AND IC RESTORATIVE AREA
Square Footage Cooled :  3160
Number of People to use Cooled Space :  120

Legal Actions

Date InitiatedCase #Case TypeViolationFine AmountDate Imposed
10/27/2017 2017013139 Rule Variance/WaiverAdministrative Rule N/A 11/27/2017
09/08/2016 2016010577 FineSurvey $1,000.00 05/09/2017
09/08/2016 2016010577 Conditional LicenseSurvey N/A 05/09/2017
05/12/2015 2015004763 FineSurvey $2,500.00 09/15/2015
05/12/2015 2015004763 Conditional LicenseSurvey N/A 09/15/2015
04/08/2015 2015003527 FineSurvey $2,500.00 09/15/2015
04/08/2015 2015003527 Conditional LicenseSurvey N/A 09/15/2015
03/05/2015 2015002149 FineSurvey $500.00 06/03/2015
12/04/2013 2013012679 FineSurvey $10,000.00 04/21/2014
12/04/2013 2013012679 Conditional LicenseSurvey N/A 04/21/2014
03/31/2004 2004003074 FineSurvey $21,000.00 09/06/2005
03/31/2004 2004003074 Six month survey cycleSurvey N/A 03/17/2004
Please note the legal actions above may have been issued to a prior owner. The Final Order displays the name of the licensee responsible for the legal action that was taken.

Consumer Guides:



Attn Providers: Requests for changes in data must be sent in writing to the AHCA licensing office.
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