Healthcare Provider Details

I. General information

NPI: 1750385308
Provider Name (Legal Business Name): ISLF REGENTS PARK WINTER PARK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 N SEMORAN BLVD
WINTER PARK FL
32792-2840
US

IV. Provider business mailing address

1675 PALM BEACH LAKES BLVD STE 400
WEST PALM BEACH FL
33401-2110
US

V. Phone/Fax

Practice location:
  • Phone: 407-679-1515
  • Fax: 407-679-0545
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 NumberSNF1469096
License Number StateFL

VIII. Authorized Official

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