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General NPI Number Information
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NPI Number | 1801890272
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Entity Type | Organization
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Legal Business Name | FLORIDA LIVING OPTIONS INC.
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 08/26/2009
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Provider Practice Location Address
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Address Line | 851 W LUMSDEN RD
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City | BRANDON
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State | FL
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Zip | 33511-6280
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Country | US
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Telephone | 813-661-8998
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Fax | 813-661-3725
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Provider Business Mailing Address
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Address Line | 851 W LUMSDEN RD
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City | BRANDON
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State | FL
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Zip | 33511-6280
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Country | US
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Telephone | 813-661-8998
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Fax | 813-661-3725
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Authorized Official
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Title or Position | CFO
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Name | MR. RONALD J WILSON
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Credential |
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Telephone | 309-343-1550
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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 | SNF16310961
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License Number State | FL
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