Healthcare Provider Details

I. General information

NPI: 1114217114
Provider Name (Legal Business Name): CPLACE OF ST. PETE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 ROOSEVELT BLVD N
ST PETERSBURG FL
33716-3816
US

IV. Provider business mailing address

10501 ROOSEVELT BLVD N
ST PETERSBURG FL
33716-3816
US

V. Phone/Fax

Practice location:
  • Phone: 727-577-3800
  • Fax: 727-578-5255
Mailing address:
  • Phone: 727-577-3800
  • Fax: 727-578-5255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. LYNDA S. HEBBELN
Title or Position: CFO
Credential:
Phone: 727-723-3000