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General NPI Number Information
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NPI Number | 1558678284
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Entity Type | Organization
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Legal Business Name | HILLSBOROUGH EXTENDED CARE, LLC
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Dates
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Enumeration Date | 09/01/2010
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Last Update Date | 04/03/2012
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Provider Practice Location Address
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Address Line | 19091 DALE MABRY HWY N
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City | LUTZ
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State | FL
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Zip | 33548-4982
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Country | US
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Telephone | 561-366-6600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 31809
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33420-1809
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Country | US
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Telephone | 561-366-6600
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. PAUL M WALCZAK II
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Credential |
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Telephone | 561-366-6600
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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 | TBD
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License Number State | FL
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