=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992780969
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLORIDA HEALTHCARE MANAGEMENT LLLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2005
-----------------------------------------------------
Last Update Date | 05/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1556 MAGUIRE ROAD
-----------------------------------------------------
City | OCOEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34761-2982
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-877-2272
-----------------------------------------------------
Fax | 407-877-6220
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1556 MAGUIRE ROAD
-----------------------------------------------------
City | OCOEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34761-2982
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-877-2272
-----------------------------------------------------
Fax | 407-877-6220
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT ADMINISTRATOR
-----------------------------------------------------
Name | MR. STEPHEN RYKIEL
-----------------------------------------------------
Credential | NHA
-----------------------------------------------------
Telephone | 407-877-2272
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | SNF13870961
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------