Healthcare Provider Details

I. General information

NPI: 1780106864
Provider Name (Legal Business Name): WESTMINSTER PINES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 07/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 TOWERVIEW DR
ST AUGUSTINE FL
32092-2790
US

IV. Provider business mailing address

80 W LUCERNE CIR
ORLANDO FL
32801-3779
US

V. Phone/Fax

Practice location:
  • Phone: 904-940-4800
  • Fax:
Mailing address:
  • Phone: 407-839-5050
  • Fax: 407-849-1718

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: HENRY T KEITH
Title or Position: SENIOR VICE PRESIDENT AND CFO
Credential: CPA
Phone: 407-839-5050