Healthcare Provider Details

I. General information

NPI: 1124022603
Provider Name (Legal Business Name): LTCSP PASADENA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 PASADENA AVE S
SOUTH PASADENA FL
33707-3716
US

IV. Provider business mailing address

1675 PALM BEACH LAKES BLVD SUITE 900
WEST PALM BEACH FL
33401
US

V. Phone/Fax

Practice location:
  • Phone: 727-347-1257
  • Fax: 727-381-5407
Mailing address:
  • Phone: 561-801-7600
  • Fax: 414-268-4811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF14320962
License Number StateFL

VIII. Authorized Official

Name: HOWARD JAFFE
Title or Position: PRESIDENT
Credential:
Phone: 215-346-6454