MEDICARE: PHI 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	SNF130470981	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35960917	OTHER	FL	STATE FACILITY MDS ID NUM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770579906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHI LLC

Provider Business Mailing Address
First Line	:	6767 86TH AVE NORTH
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33782-4597
Country	:	US
Telephone Number	:	727-548-5566
Fax Number	:	727-548-6644

Provider Business Practice Location Address
First Line	:	6767 86TH AVE NORTH
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33782-4597
Country	:	US
Telephone Number	:	727-548-5566
Fax Number	:	727-548-6644

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. JOYCE S DENHAM
Credential	:	LNHA
Telephone Number	:	727-548-5566

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	06/26/2008

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Directions to “PHI LLC ” Practice Location

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