Provider Demographics
NPI:1104011873
Name:SENIOR CARE OF HIDDEN OAKS OPERATOR LLC
Entity Type:Organization
Organization Name:SENIOR CARE OF HIDDEN OAKS OPERATOR LLC
Other - Org Name:HIDDEN OAKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:R
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-341-2700
Mailing Address - Street 1:1240 MARBELLA PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-7906
Mailing Address - Country:US
Mailing Address - Phone:813-341-2700
Mailing Address - Fax:813-651-4183
Practice Address - Street 1:3625 HIDDEN TREE LANE
Practice Address - Street 2:
Practice Address - City:FORT MEYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8388
Practice Address - Country:US
Practice Address - Phone:239-939-1393
Practice Address - Fax:239-939-1149
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENIOR CARE GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5531310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility