Healthcare Provider Details

I. General information

NPI: 1801890272
Provider Name (Legal Business Name): FLORIDA LIVING OPTIONS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 W LUMSDEN RD
BRANDON FL
33511-6280
US

IV. Provider business mailing address

851 W LUMSDEN RD
BRANDON FL
33511-6280
US

V. Phone/Fax

Practice location:
  • Phone: 813-661-8998
  • Fax: 813-661-3725
Mailing address:
  • Phone: 813-661-8998
  • Fax: 813-661-3725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF16310961
License Number StateFL

VIII. Authorized Official

Name: MR. RONALD J WILSON
Title or Position: CFO
Credential:
Phone: 309-343-1550