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NPI Code Detail

MEDICARE: LTCSP PLANT CITY, LLC

MEDICARE: LTCSP PLANT CITY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilitySNF1099096FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447255534
Entity Type Code : Organization
Provider Name (Legal Business Name) : LTCSP PLANT CITY, LLC
Provider Business Mailing Address
First Line : 1675 PALM BEACH LAKES BLVD
Second Line : SUITE 900
City : WEST PALM BEACH
State : FL
Zip : 33401
Country : US
Telephone Number : 561-801-7600
Fax Number :
Provider Business Practice Location Address
First Line : 2202 W OAK AVE
Second Line :
City : PLANT CITY
State : FL
Zip : 33563-7222
Country : US
Telephone Number : 813-754-3761
Fax Number : 813-754-5301
Authorized Official
Title or Position : PRESIDENT
Name : HOWARD JAFFE
Credential :
Telephone Number : 215-346-6454
Provider Enumeration Date : 06/16/2005
Last Update Date : 12/21/2013

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Directions to “LTCSP PLANT CITY, LLC ” Practice Location

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