1821289190 NPI number — LP HIALEAH GARDENS LLC

Table of content: (NPI 1821289190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821289190 NPI number — LP HIALEAH GARDENS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LP HIALEAH GARDENS 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:
SIGNATURE HEALTHCARE CENTER OF WATERFORD
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:
1821289190
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12201 BLUEGRASS PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40299-2361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-568-7800
Provider Business Mailing Address Fax Number:
502-568-7150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8333 W OKEECHOBEE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIALEAH GARDENS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33016-2109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-556-9900
Provider Business Practice Location Address Fax Number:
305-821-8027
Provider Enumeration Date:
08/05/2007

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: 314000000X , with the licence number:  SNF1586096 , 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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