Provider Demographics
NPI:1467417857
Name:FLORIDA HHC CORP.
Entity Type:Organization
Organization Name:FLORIDA HHC CORP.
Other - Org Name:MARTHA'S RETIREMENT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:ROEGELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-522-4439
Mailing Address - Street 1:10542 51ST TER N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33708-3308
Mailing Address - Country:US
Mailing Address - Phone:727-391-2909
Mailing Address - Fax:727-391-2909
Practice Address - Street 1:3586 53RD AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33714-2412
Practice Address - Country:US
Practice Address - Phone:727-522-4439
Practice Address - Fax:727-521-9520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5336310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1405586-00Medicaid
FL680926-00Medicaid