Provider Demographics
NPI:1467408054
Name:PARADISE PINES HEALTH CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:PARADISE PINES HEALTH CARE ASSOCIATES LLC
Other - Org Name:HARTS HARBOR HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-751-1834
Mailing Address - Street 1:11565 HARTS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-3777
Mailing Address - Country:US
Mailing Address - Phone:904-751-1834
Mailing Address - Fax:904-751-0272
Practice Address - Street 1:11565 HARTS RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-3777
Practice Address - Country:US
Practice Address - Phone:904-751-1834
Practice Address - Fax:904-751-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF15640961314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025241700Medicaid
105632Medicare Oscar/Certification