Provider Demographics
NPI:1093024143
Name:PRIME PROPERTIES OF CLEARWATER INC
Entity Type:Organization
Organization Name:PRIME PROPERTIES OF CLEARWATER INC
Other - Org Name:DBA BELLEAIR COUNTRY HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BORTKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-524-1390
Mailing Address - Street 1:2298 BELLEAIR ROAD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764
Mailing Address - Country:US
Mailing Address - Phone:727-524-1390
Mailing Address - Fax:727-524-0171
Practice Address - Street 1:2298 BELLEAIR ROAD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764
Practice Address - Country:US
Practice Address - Phone:727-524-1390
Practice Address - Fax:727-524-0171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8782310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility