1659694321 NPI number — LP ST. PETERSBURG, LLC

Table of content: (NPI 1659694321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659694321 NPI number — LP ST. PETERSBURG, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LP ST. PETERSBURG, LLC
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:
GOLFVIEW HEALTHCARE CENTER
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:
1659694321
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3636 10TH AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33713-6528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-323-3611
Provider Business Mailing Address Fax Number:
727-327-5802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3636 10TH AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33713-6528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-323-3611
Provider Business Practice Location Address Fax Number:
727-327-5802
Provider Enumeration Date:
03/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HARRISON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
502-568-7800

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  SNF11770962 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: SNF11770962 , 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)





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