Healthcare Provider Details

I. General information

NPI: 1033166475
Provider Name (Legal Business Name): MANOR CARE OF WINTER PARK FL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 LOCH LOMOND DR
WINTER PARK FL
32792-4183
US

IV. Provider business mailing address

333 N SUMMIT ST ATTN: MARTIN D. ALLEN
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 407-628-5418
  • Fax: 407-628-4024
Mailing address:
  • Phone: 419-252-5734
  • Fax: 877-385-9446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1309096
License Number StateFL

VIII. Authorized Official

Name: MR. MARTIN D ALLEN
Title or Position: DIRECTOR
Credential:
Phone: 419-252-5734