1720081011 NPI number — FLORIDA LIVING OPTIONS INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720081011 NPI number — FLORIDA LIVING OPTIONS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA LIVING OPTIONS INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
1ST FLORIDA LIVING OPTIONS LLC HAWTHORNE HEALTH AND REHAB OF OCALA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720081011
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4100 SW 33RD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34474-4466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-237-7776
Provider Business Mailing Address Fax Number:
352-237-5551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4100 SW 33RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34474-4466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-237-7776
Provider Business Practice Location Address Fax Number:
352-237-5551
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
309-343-1550

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  SNF1541096 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 025345600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: M-35 . This is a "BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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