Basic Information
| Provider Information | |||||||||
| NPI: | 1407347982 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ARCHER HEALTH VENTURES, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PLAZA HEALTH AND REHAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2380 SADLER RD | ||||||||
| Address2: | |||||||||
| City: | FERNANDINA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320340415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043211909 | ||||||||
| FaxNumber: | 9043211790 | ||||||||
| Practice Location | |||||||||
| Address1: | 4842 SW ARCHER RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326083813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523768821 | ||||||||
| FaxNumber: | 3523777606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2018 | ||||||||
| LastUpdateDate: | 05/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | BRIGHTWELL | ||||||||
| AuthorizedOfficialFirstName: | ANNESLEY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | REGIONAL BUSINESS OFFICE MANAGERS | ||||||||
| AuthorizedOfficialTelephone: | 9047531870 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1568096 | FL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.