Healthcare Provider Details

I. General information

NPI: 1720034341
Provider Name (Legal Business Name): BRENTWOOD HEALTH CARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 N BRENTWOOD CIR
LECANTO FL
34461-8536
US

IV. Provider business mailing address

2333 N BRENTWOOD CIR
LECANTO FL
34461-8536
US

V. Phone/Fax

Practice location:
  • Phone: 352-746-6611
  • Fax: 352-746-0866
Mailing address:
  • Phone: 352-746-6611
  • Fax: 352-746-0866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1200096
License Number StateFL

VIII. Authorized Official

Name: LAURA L. ETTER
Title or Position: MANAGER
Credential:
Phone: 352-746-6611