Healthcare Provider Details

I. General information

NPI: 1912924952
Provider Name (Legal Business Name): SYLVAN HEALTH SYSTEMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 REGENCY OAKS BLVD
CLEARWATER FL
33759-1509
US

IV. Provider business mailing address

2770 REGENCY OAKS BLVD
CLEARWATER FL
33759-1509
US

V. Phone/Fax

Practice location:
  • Phone: 727-791-1500
  • Fax: 727-791-7743
Mailing address:
  • Phone: 727-791-1500
  • Fax: 727-791-7743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number022
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number105
License Number StateFL

VIII. Authorized Official

Name: MS. BETTY RUTH BREDEN
Title or Position: ADMINISTRATOR
Credential: LICENSED NHA
Phone: 727-791-1500