Provider Demographics
NPI:1043655079
Name:HERNANDO ENTERPRISE,INC.
Entity Type:Organization
Organization Name:HERNANDO ENTERPRISE,INC.
Other - Org Name:PLEASANT GROVE MANOR ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-726-2555
Mailing Address - Street 1:5701 S PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-8385
Mailing Address - Country:US
Mailing Address - Phone:352-726-2555
Mailing Address - Fax:352-726-7011
Practice Address - Street 1:300 71ST ST STE 400
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-3092
Practice Address - Country:US
Practice Address - Phone:305-868-1830
Practice Address - Fax:305-868-2304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10113310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility