=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598769200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENIOR HEALTH-SOUTH HERITAGE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2005
-----------------------------------------------------
Last Update Date | 01/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 718 22ND AVE S
-----------------------------------------------------
City | ST PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33705-3004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-894-5125
-----------------------------------------------------
Fax | 727-894-6839
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1665 PALM BEACH LAKES BLVD STE 400
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33401-2108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-801-7600
-----------------------------------------------------
Fax | 727-894-6839
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | HOWARD JAFFE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-346-6454
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | SNF15030961
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------