1720081011 NPI number — FLORIDA LIVING OPTIONS INC.

Table of content: (NPI 1720081011)

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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