Healthcare Provider Details

I. General information

NPI: 1952364572
Provider Name (Legal Business Name): PLYMOUTH HARBOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 JOHN RINGLING BLVD
SARASOTA FL
34236-1542
US

IV. Provider business mailing address

700 JOHN RINGLING BLVD
SARASOTA FL
34236-1542
US

V. Phone/Fax

Practice location:
  • Phone: 941-365-2600
  • Fax: 941-361-7163
Mailing address:
  • Phone: 941-365-2600
  • Fax: 941-361-7163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1449096
License Number StateFL

VIII. Authorized Official

Name: MS. NATALLIA DZIATSEL
Title or Position: VP/CFO
Credential:
Phone: 941-365-2600