Basic Information
| Provider Information | |||||||||
| NPI: | 1609869825 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA PRESBYTERIAN HOMES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 LAKE HUNTER DR | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338031297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636885521 | ||||||||
| FaxNumber: | 8636874088 | ||||||||
| Practice Location | |||||||||
| Address1: | 909 S LAKESIDE AVE | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338031031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636885521 | ||||||||
| FaxNumber: | 8636874088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | KYM | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8636885521 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | FL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.