Provider Demographics
NPI:1063634517
Name:PINELLAS COUNTY HOUSING AUTHORITY
Entity Type:Organization
Organization Name:PINELLAS COUNTY HOUSING AUTHORITY
Other - Org Name:MAGNOLIA GARDENS ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:HADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-489-6440
Mailing Address - Street 1:3800 62ND AVE NORTH
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781
Mailing Address - Country:US
Mailing Address - Phone:727-489-6440
Mailing Address - Fax:727-489-6452
Practice Address - Street 1:3800 62ND AVE NORTH
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781
Practice Address - Country:US
Practice Address - Phone:727-489-6440
Practice Address - Fax:727-489-6452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLALF10314310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142022400Medicaid
FL685931300Medicaid