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General NPI Number Information
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NPI Number | 1093024143
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Entity Type | Organization
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Legal Business Name | PRIME PROPERTIES OF CLEARWATER INC
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Dates
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Enumeration Date | 10/06/2010
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Last Update Date | 10/06/2010
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Provider Practice Location Address
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Address Line | 2298 BELLEAIR ROAD
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City | CLEARWATER
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State | FL
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Zip | 33764
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Country | US
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Telephone | 727-524-1390
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Fax | 727-524-0171
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Provider Business Mailing Address
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Address Line | 2298 BELLEAIR ROAD
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City | CLEARWATER
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State | FL
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Zip | 33764
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Country | US
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Telephone | 727-524-1390
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Fax | 727-524-0171
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. WILLIAM BORTKO
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Credential |
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Telephone | 727-524-1390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 8782
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License Number State | FL
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