Provider Demographics
NPI:1225053473
Name:PRESBYTERIAN RETIREMENT COMMUNITIES, INC.
Entity Type:Organization
Organization Name:PRESBYTERIAN RETIREMENT COMMUNITIES, INC.
Other - Org Name:WESTMINSTER COMMUNITIES OF BRADENTON, WESTMINSTER MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:T
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-839-5050
Mailing Address - Street 1:80 W LUCERNE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3779
Mailing Address - Country:US
Mailing Address - Phone:407-839-5050
Mailing Address - Fax:407-849-1718
Practice Address - Street 1:1700 21ST AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-5717
Practice Address - Country:US
Practice Address - Phone:941-748-4161
Practice Address - Fax:941-748-6673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1597096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020942200Medicaid
FL1222930003OtherDMERC SUPPLIER NUMBER
FL020942200Medicaid