Provider Demographics
NPI:1073585808
Name:KIRBICORT, INC.
Entity Type:Organization
Organization Name:KIRBICORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:PRUNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:407-971-8115
Mailing Address - Street 1:2455 CURRYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32766-9152
Mailing Address - Country:US
Mailing Address - Phone:407-971-8115
Mailing Address - Fax:407-977-9458
Practice Address - Street 1:2901 YULE CT
Practice Address - Street 2:
Practice Address - City:CHRISTMAS
Practice Address - State:FL
Practice Address - Zip Code:32709-8717
Practice Address - Country:US
Practice Address - Phone:407-568-6342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7G343A-C311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684718896Medicaid