1225053473 NPI number — PRESBYTERIAN RETIREMENT COMMUNITIES, INC.

Table of content: (NPI 1225053473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225053473 NPI number — PRESBYTERIAN RETIREMENT COMMUNITIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESBYTERIAN RETIREMENT COMMUNITIES, 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:
Provider Other Organization Name Type Code:
6
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:
1225053473
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 W LUCERNE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32801-3779
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-839-5050
Provider Business Mailing Address Fax Number:
407-849-1718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 21ST AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34205-5717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-748-4161
Provider Business Practice Location Address Fax Number:
941-748-6673
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KEITH
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
407-839-5050

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  SNF1597096 , 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: 020942200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1222930003 . This is a "DMERC SUPPLIER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 020942200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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