Healthcare Provider Details

I. General information

NPI: 1114973740
Provider Name (Legal Business Name): SPRING HILL HEALTH CARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 05/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12170 CORTEZ BLVD
BROOKSVILLE FL
34613-5578
US

IV. Provider business mailing address

12170 CORTEZ BLVD
BROOKSVILLE FL
34613-5578
US

V. Phone/Fax

Practice location:
  • Phone: 352-597-5100
  • Fax: 352-597-5020
Mailing address:
  • Phone: 352-597-5100
  • Fax: 352-597-5020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF130470973
License Number StateFL

VIII. Authorized Official

Name: MATTHEW E. PEDERSON
Title or Position: MANAGER
Credential:
Phone: 352-597-5100