Healthcare Provider Details

I. General information

NPI: 1104861871
Provider Name (Legal Business Name): PRESBYTERIAN RETIREMENT COMMUNITIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S LAKEMONT AVE
WINTER PARK FL
32792-5469
US

IV. Provider business mailing address

80 W LUCERNE CIR
ORLANDO FL
32801-3779
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-4083
  • Fax: 407-645-4407
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 NumberSNF1612096
License Number StateFL

VIII. Authorized Official

Name: MR. HENRY T KEITH
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 407-839-5050