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NPI Code Detail

MEDICARE: 2600 HIGHLANDS BOULEVARD NORTH LLC

MEDICARE: 2600 HIGHLANDS BOULEVARD NORTH 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
1314000000XSkilled Nursing FacilitySNF 10390964FL

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 : 1962425041
Entity Type Code : Organization
Provider Name (Legal Business Name) : 2600 HIGHLANDS BOULEVARD NORTH LLC
Provider Business Mailing Address
First Line : 101 SUN AVE NE
Second Line : COMPLIANCE DEPARTMENT
City : ALBUQUERQUE
State : NM
Zip : 87109-4373
Country : US
Telephone Number : 505-468-5604
Fax Number : 505-468-4681
Provider Business Practice Location Address
First Line : 2600 HIGHLANDS BLVD N
Second Line :
City : PALM HARBOR
State : FL
Zip : 34684-2114
Country : US
Telephone Number : 727-785-5671
Fax Number : 727-785-5486
Authorized Official
Title or Position : PRESIDENT DIRECTOR
Name : WILLIAM A MATHIES
Credential :
Telephone Number : 505-821-3355
Provider Enumeration Date : 07/26/2006
Last Update Date : 09/30/2009

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