Healthcare Provider Details

I. General information

NPI: 1982601670
Provider Name (Legal Business Name): HEATHER HILL NURSING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6630 KENTUCKY AVE
NEW PORT RICHEY FL
34653-2712
US

IV. Provider business mailing address

6630 KENTUCKY AVE
NEW PORT RICHEY FL
34653-2712
US

V. Phone/Fax

Practice location:
  • Phone: 727-849-6939
  • Fax: 727-843-0262
Mailing address:
  • Phone: 727-849-6939
  • Fax: 727-843-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1217096
License Number StateFL

VIII. Authorized Official

Name: MS. MARIA ALMA OWENS-WICKER
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 727-849-6939