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General NPI Number Information
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NPI Number | 1831433531
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Entity Type | Organization
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Legal Business Name | FLORIDA PH-I, LLC
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Dates
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Enumeration Date | 11/19/2012
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Last Update Date | 11/19/2012
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Provider Practice Location Address
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Address Line | 16 LAKE HUNTER DR
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City | LAKELAND
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State | FL
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Zip | 33803-1297
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Country | US
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Telephone | 863-577-6040
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Fax |
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Provider Business Mailing Address
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Address Line | 16 LAKE HUNTER DR
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City | LAKELAND
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State | FL
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Zip | 33803-1297
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ASST TREASURER/DIRECTOR OF FINANCE
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Name | PATTY FEKETE
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Credential |
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Telephone | 863-577-6040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL4790
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | SNF130470964
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License Number State | FL
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