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General NPI Number Information
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NPI Number | 1750385308
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Entity Type | Organization
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Legal Business Name | ISLF REGENTS PARK WINTER PARK LLC
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Dates
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Enumeration Date | 06/10/2005
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Last Update Date | 12/18/2019
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Provider Practice Location Address
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Address Line | 558 N SEMORAN BLVD
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City | WINTER PARK
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State | FL
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Zip | 32792-2840
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Country | US
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Telephone | 407-679-1515
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Fax | 407-679-0545
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Provider Business Mailing Address
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Address Line | 1675 PALM BEACH LAKES BLVD STE 400
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-2110
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Country | US
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Telephone | 561-801-7600
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Fax | 414-268-4811
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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 | SNF1469096
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License Number State | FL
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