Healthcare Provider Details

I. General information

NPI: 1093946782
Provider Name (Legal Business Name): BEAR CREEK LESSEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8041 STATE ROAD 52
HUDSON FL
34667-6726
US

IV. Provider business mailing address

611 COMMERCE ST SUITE 3125
NASHVILLE TN
37203-3742
US

V. Phone/Fax

Practice location:
  • Phone: 727-863-5488
  • Fax: 727-862-9558
Mailing address:
  • Phone: 615-255-0009
  • Fax: 615-242-1822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES P. EARLE III
Title or Position: PRESIDENT
Credential:
Phone: 615-255-0009