MEDICARE: SCG HARBOURWOOD LLC

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
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	M3K	OTHER	FL	BLUE CROSS AND BLUE SHIELD

General Provider Information

NPI Number	:	1184616245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCG HARBOURWOOD LLC

Provider Business Mailing Address
First Line	:	1240 MARBELLA PLAZA DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619
Country	:	US
Telephone Number	:	813-341-2700
Fax Number	:	813-341-2755

Provider Business Practice Location Address
First Line	:	2855 GULF TO BAY BLVD
Second Line	:	BLDG #31
City	:	CLEARWATER
State	:	FL
Zip	:	33759-4087
Country	:	US
Telephone Number	:	727-724-6800
Fax Number	:	727-724-6848

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROBERT DANIEL VAUGHAN
Credential	:
Telephone Number	:	813-341-2700

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	02/07/2011

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Directions to “SCG HARBOURWOOD LLC ” Practice Location

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