MEDICARE: AVON PARK ROYAL HOLDINGS 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	SNF12290951	FL

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	:	1477731529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVON PARK ROYAL HOLDINGS LLC

Provider Business Mailing Address
First Line	:	1213 W STRATFORD RD
Second Line	:
City	:	AVON PARK
State	:	FL
Zip	:	33825-8091
Country	:	US
Telephone Number	:	863-453-6674
Fax Number	:	863-453-9473

Provider Business Practice Location Address
First Line	:	1213 W STRATFORD RD
Second Line	:
City	:	AVON PARK
State	:	FL
Zip	:	33825-8091
Country	:	US
Telephone Number	:	863-453-6674
Fax Number	:	863-453-9473

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. PAMELA MATHEIS
Credential	:
Telephone Number	:	863-453-6674

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	01/09/2025

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