Provider Demographics
NPI:1437683448
Name:HABANA HEALTH CARE CENTER
Entity Type:Organization
Organization Name:HABANA HEALTH CARE CENTER
Other - Org Name:GENESIS REHAB SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PTA
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LANGER
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:813-601-1349
Mailing Address - Street 1:2916 HABANA WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23053 PRESERVE CT
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-8758
Practice Address - Country:US
Practice Address - Phone:813-601-1349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26999314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility