Healthcare Provider Details

I. General information

NPI: 1578320172
Provider Name (Legal Business Name): EAGLE LAKE NURSING & REHAB OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 66TH ST N
SAINT PETERSBURG FL
33710-6224
US

IV. Provider business mailing address

7951 SW 6TH ST STE 116
PLANTATION FL
33324-3211
US

V. Phone/Fax

Practice location:
  • Phone: 727-345-9331
  • Fax:
Mailing address:
  • Phone: 786-785-9165
  • Fax:

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: MR. EDEN NAJMAN
Title or Position: C.E.O.
Credential:
Phone: 786-785-9156