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NPI Code Detail

MEDICARE: M-K OF HAINES CITY L L C

MEDICARE: M-K OF HAINES CITY L L C
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 FacilitySNF1190095FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154328102
Entity Type Code : Organization
Provider Name (Legal Business Name) : M-K OF HAINES CITY L L C
Provider Business Mailing Address
First Line : 409 S 10TH ST
Second Line :
City : HAINES CITY
State : FL
Zip : 33844-5603
Country : US
Telephone Number : 863-422-8656
Fax Number : 863-422-8008
Provider Business Practice Location Address
First Line : 409 S 10TH ST
Second Line :
City : HAINES CITY
State : FL
Zip : 33844-5603
Country : US
Telephone Number : 863-422-8656
Fax Number : 863-422-8008
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. TOM GLASS
Credential :
Telephone Number : 863-422-8656
Provider Enumeration Date : 07/06/2005
Last Update Date : 03/19/2009

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1447473855 — BARBARA WEBB
Practice Location Address:
409 S 10TH ST
HAINES CITY, FL
33844-5603
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1306060363 — MR. WILLIAM T RIGBY PTA
Practice Location Address:
409 S 10TH ST
HAINES CITY, FL
33844-5603
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Practice Fax:
1154545184 — MARISELL ALBERT PTA
Practice Location Address:
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33844-5603
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Directions to “M-K OF HAINES CITY L L C ” Practice Location

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