Healthcare Provider Details

I. General information

NPI: 1285679597
Provider Name (Legal Business Name): BEAR CREEK NURSING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 04/30/2014
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

8041 STATE ROAD 52
HUDSON FL
34667-6726
US

V. Phone/Fax

Practice location:
  • Phone: 727-863-5488
  • Fax: 727-862-9558
Mailing address:
  • Phone: 727-863-5488
  • Fax: 727-862-9558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF10460962
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIA A OWENS-WICKER
Title or Position: ADMINISTRATOR
Credential: NURSING HOME ADMINIS
Phone: 727-863-5488