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NPI Code Detail

MEDICARE: PELICAN BAY RETIREMENT SERVICES INC

MEDICARE: PELICAN BAY RETIREMENT SERVICES INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilitySNF1175096FL

General Provider Information

NPI Number : 1083663991
Entity Type Code : Organization
Provider Name (Legal Business Name) : PELICAN BAY RETIREMENT SERVICES INC
Provider Business Mailing Address
First Line : 100 GLENVIEW PL
Second Line :
City : NAPLES
State : FL
Zip : 34108-3137
Country : US
Telephone Number : 239-591-0011
Fax Number :
Provider Business Practice Location Address
First Line : 100 GLENVIEW PL
Second Line :
City : NAPLES
State : FL
Zip : 34108-3137
Country : US
Telephone Number : 239-591-0011
Fax Number :
Authorized Official
Title or Position : PRESIDENT & TREASURER
Name : KENNETH WILLIAMS
Credential :
Telephone Number : 239-591-4235
Provider Enumeration Date : 05/08/2006
Last Update Date : 03/14/2019

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Directions to “PELICAN BAY RETIREMENT SERVICES INC ” Practice Location

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