Healthcare Provider Details

I. General information

NPI: 1740337526
Provider Name (Legal Business Name): OSPREY OF NORTH FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 N MAIN ST
BUSHNELL FL
33513-5045
US

IV. Provider business mailing address

1104 N MAIN ST
BUSHNELL FL
33513-5045
US

V. Phone/Fax

Practice location:
  • Phone: 352-568-8777
  • Fax: 352-568-8780
Mailing address:
  • Phone: 352-568-8777
  • Fax: 352-568-8780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ROBERT DANIEL MEAD
Title or Position: REGIONAL VICE PRESIDENT
Credential:
Phone: 352-568-8777