Healthcare Provider Details

I. General information

NPI: 1477731529
Provider Name (Legal Business Name): AVON PARK ROYAL HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 W STRATFORD RD
AVON PARK FL
33825-8091
US

IV. Provider business mailing address

1213 W STRATFORD RD
AVON PARK FL
33825-8091
US

V. Phone/Fax

Practice location:
  • Phone: 863-453-6674
  • Fax: 863-453-9473
Mailing address:
  • Phone: 863-453-6674
  • Fax: 863-453-9473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF12290951
License Number StateFL

VIII. Authorized Official

Name: MRS. PAMELA MATHEIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 863-453-6674