Provider Demographics
NPI:1285679597
Name:BEAR CREEK NURSING CENTER, LLC
Entity Type:Organization
Organization Name:BEAR CREEK NURSING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:OWENS-WICKER
Authorized Official - Suffix:
Authorized Official - Credentials:NURSING HOME ADMINIS
Authorized Official - Phone:727-863-5488
Mailing Address - Street 1:8041 STATE ROAD 52
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6726
Mailing Address - Country:US
Mailing Address - Phone:727-863-5488
Mailing Address - Fax:727-862-9558
Practice Address - Street 1:8041 STATE ROAD 52
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6726
Practice Address - Country:US
Practice Address - Phone:727-863-5488
Practice Address - Fax:727-862-9558
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH SERVICES MANAGEMENT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-19
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF10460962314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
219410OtherAMERIGROUP
FL022856700Medicaid
14773OtherSTAYWELL/WELLCARE
01459OtherUNIVERSAL HC
103501OtherCITRUS HEALTHCARE
FLL06OtherBCBS
7105581OtherUNITED HEALTHCARE
FL022856700Medicaid
01459OtherUNIVERSAL HC