1063427805 NPI number — ZEPHYR HAVEN HEALTH & REHAB CENTER INC

Table of content: (NPI 1063427805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063427805 NPI number — ZEPHYR HAVEN HEALTH & REHAB CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZEPHYR HAVEN HEALTH & REHAB CENTER 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:
ADVENTHEALTH CARE CENTER ZEPHYRHILLS SOUTH
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:
1063427805
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 HOPE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTAMONTE SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32714-1502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-975-3000
Provider Business Mailing Address Fax Number:
407-975-3090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38250 A AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZEPHYRHILLS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33542-5759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-782-5508
Provider Business Practice Location Address Fax Number:
813-783-1586
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RODMAN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ASST. SECRETARY
Authorized Official Telephone Number:
407-975-3011

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  SNF16150961 , 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: 021274100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 032039100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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