Provider Demographics
NPI:1093183725
Name:SLAVKO LLC
Entity Type:Organization
Organization Name:SLAVKO LLC
Other - Org Name:DBA HENDERSON HOUSE ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-669-9278
Mailing Address - Street 1:14806 COUNTY ROAD 450
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:FL
Mailing Address - Zip Code:32784-8125
Mailing Address - Country:US
Mailing Address - Phone:352-669-9278
Mailing Address - Fax:352-669-9278
Practice Address - Street 1:907 E ORANGE AVE
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6249
Practice Address - Country:US
Practice Address - Phone:352-357-8258
Practice Address - Fax:352-357-2375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL6622310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility