Basic Information
| Provider Information | |||||||||
| NPI: | 1750643037 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA PRESBYTERIAN HOMES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 LAKE HUNTER DR | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338031297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8635776040 | ||||||||
| FaxNumber: | 8636874088 | ||||||||
| Practice Location | |||||||||
| Address1: | 16 LAKE HUNTER DR | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338031297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8635776040 | ||||||||
| FaxNumber: | 8636874088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2012 | ||||||||
| LastUpdateDate: | 06/12/2012 | ||||||||
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| AuthorizedOfficialLastName: | FEKETE | ||||||||
| AuthorizedOfficialFirstName: | PATTY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASST TREASURER/DIRECTOR OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 8635776040 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FLORIDA PRESBYTERIAN HOMES, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | N | Nursing & Custodial Care Facilities | Assisted Living Facility | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.