Provider Demographics
NPI:1326267519
Name:SOUTH CENTRAL NURSING HOMES OF ZEPHYRHILLS INC
Entity Type:Organization
Organization Name:SOUTH CENTRAL NURSING HOMES OF ZEPHYRHILLS INC
Other - Org Name:ZEPHYR HAVEN NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST. SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-975-3011
Mailing Address - Street 1:602 COURTLAND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-1360
Mailing Address - Country:US
Mailing Address - Phone:407-975-3000
Mailing Address - Fax:407-975-3090
Practice Address - Street 1:38250 A AVE
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-5759
Practice Address - Country:US
Practice Address - Phone:813-782-5508
Practice Address - Fax:813-783-1586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF16150961314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021274100Medicaid
FL3948320001Medicare NSC
FL021274100Medicaid