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General NPI Number Information
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NPI Number | 1447255534
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Entity Type | Organization
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Legal Business Name | LTCSP PLANT CITY, LLC
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 12/21/2013
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Provider Practice Location Address
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Address Line | 2202 W OAK AVE
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City | PLANT CITY
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State | FL
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Zip | 33563-7222
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Country | US
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Telephone | 813-754-3761
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Fax | 813-754-5301
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Provider Business Mailing Address
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Address Line | 1675 PALM BEACH LAKES BLVD SUITE 900
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City | WEST PALM BEACH
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State | FL
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Zip | 33401
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Country | US
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Telephone | 561-801-7600
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HOWARD JAFFE
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Credential |
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Telephone | 215-346-6454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | SNF1099096
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License Number State | FL
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