Healthcare Provider Details

I. General information

NPI: 1942537154
Provider Name (Legal Business Name): FLORENCE LTC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 WEST ADAMSVILLE ROAD
FLORENCE AZ
85232
US

IV. Provider business mailing address

450 WEST ADAMSVILLE ROAD
FLORENCE AZ
85132
US

V. Phone/Fax

Practice location:
  • Phone: 520-975-9151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. FRED RANDOLPH
Title or Position: ADMINISTRATOR
Credential: M.A.
Phone: 520-975-9151