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General NPI Number Information
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NPI Number | 1790731594
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Entity Type | Organization
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Legal Business Name | PLANTATION BAY 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 | 11/15/2013
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Provider Practice Location Address
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Address Line | 4641 OLD CANOE CREEK RD
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City | SAINT CLOUD
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State | FL
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Zip | 34769-1550
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Country | US
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Telephone | 407-892-7344
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Fax | 407-892-5244
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Provider Business Mailing Address
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Address Line | 4641 OLD CANOE CREEK RD
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City | SAINT CLOUD
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State | FL
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Zip | 34769-1550
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Country | US
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Telephone | 407-892-7344
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Fax | 407-892-5244
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Authorized Official
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Title or Position | MANAGER
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Name | GREG A. HOVEY
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Credential |
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Telephone | 407-892-7344
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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 | SNF16340962
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License Number State | FL
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