Basic Information
| Provider Information | |||||||||
| NPI: | 1962812545 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA PRESBYTERIAN HOMES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 LAKE HUNTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636885521 | ||||||||
| FaxNumber: | 8636874088 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 LAKESIDE AVENUE | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636885521 | ||||||||
| FaxNumber: | 8636874088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2014 | ||||||||
| LastUpdateDate: | 05/05/2014 | ||||||||
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| AuthorizedOfficialLastName: | HEHN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8635776033 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FLORIDA PRESBYTERIAN HOMES | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | AL4790 | FL | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
No ID Information.