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General NPI Number Information
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NPI Number | 1720034341
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Entity Type | Organization
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Legal Business Name | BRENTWOOD HEALTH CARE ASSOCIATES LLC
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 12/31/2013
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Provider Practice Location Address
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Address Line | 2333 N BRENTWOOD CIR
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City | LECANTO
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State | FL
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Zip | 34461-8536
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Country | US
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Telephone | 352-746-6611
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Fax | 352-746-0866
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Provider Business Mailing Address
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Address Line | 2333 N BRENTWOOD CIR
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City | LECANTO
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State | FL
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Zip | 34461-8536
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Country | US
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Telephone | 352-746-6611
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Fax | 352-746-0866
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Authorized Official
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Title or Position | MANAGER
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Name | LAURA L. ETTER
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Credential |
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Telephone | 352-746-6611
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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 | SNF1200096
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License Number State | FL
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