Healthcare Provider Details

I. General information

NPI: 1225053473
Provider Name (Legal Business Name): PRESBYTERIAN RETIREMENT COMMUNITIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 21ST AVE W
BRADENTON FL
34205-5717
US

IV. Provider business mailing address

80 W LUCERNE CIR
ORLANDO FL
32801-3779
US

V. Phone/Fax

Practice location:
  • Phone: 941-748-4161
  • Fax: 941-748-6673
Mailing address:
  • Phone: 407-839-5050
  • Fax: 407-849-1718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1597096
License Number StateFL

VIII. Authorized Official

Name: MR. HENRY T KEITH
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 407-839-5050