Provider Demographics
NPI:1245217926
Name:INTEGRATED HEALTH SERVICES AT CENTRAL FLORIDA INC
Entity Type:Organization
Organization Name:INTEGRATED HEALTH SERVICES AT CENTRAL FLORIDA INC
Other - Org Name:LAUREL POINTE HEALTH AND REHABILITATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-513-8738
Mailing Address - Street 1:703 S 29TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-3625
Mailing Address - Country:US
Mailing Address - Phone:772-466-3322
Mailing Address - Fax:772-466-8057
Practice Address - Street 1:703 S 29TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-3625
Practice Address - Country:US
Practice Address - Phone:772-466-3322
Practice Address - Fax:772-466-8057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF11600961314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL211516Medicaid
105382Medicare Oscar/Certification