Basic Information
| Provider Information | |||||||||
| NPI: | 1548680036 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROMISE HOSPITAL OF LEE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 999 YAMATO RD FL 3 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334314477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618693100 | ||||||||
| FaxNumber: | 8006451942 | ||||||||
| Practice Location | |||||||||
| Address1: | 3050 CHAMPION RING RD | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339055599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618693100 | ||||||||
| FaxNumber: | 8006451942 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2014 | ||||||||
| LastUpdateDate: | 04/10/2018 | ||||||||
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| AuthorizedOfficialLastName: | HOPWOOD | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5618693100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PROMISE HEALTHCARE, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | Y | Hospitals | Long Term Care Hospital |
No ID Information.