MEDICARE: PRESBYTERIAN RETIREMENT COMMUNITIES 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
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

General Provider Information

NPI Number	:	1194264051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESBYTERIAN RETIREMENT COMMUNITIES INC

Provider Business Mailing Address
First Line	:	2645 LAKE BALDWIN LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6827
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2645 LAKE BALDWIN LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6827
Country	:	US
Telephone Number	:	407-647-4083
Fax Number	:	407-645-4407

Authorized Official
Title or Position	:	CFO
Name	:	HENRY T KEITH
Credential	:	CPA
Telephone Number	:	407-839-5050

Provider Enumeration Date	:	02/13/2017
Last Update Date	:	08/21/2019

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