Provider Demographics
NPI:1407347982
Name:ARCHER HEALTH VENTURES, LLC
Entity Type:Organization
Organization Name:ARCHER HEALTH VENTURES, LLC
Other - Org Name:PLAZA HEALTH AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL BUSINESS OFFICE MANAGERS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGHTWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-753-1870
Mailing Address - Street 1:2380 SADLER RD
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-0415
Mailing Address - Country:US
Mailing Address - Phone:904-321-1909
Mailing Address - Fax:904-321-1790
Practice Address - Street 1:4842 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-3813
Practice Address - Country:US
Practice Address - Phone:352-376-8821
Practice Address - Fax:352-377-7606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1568096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility