Provider Demographics
NPI:1477041135
Name:LONG TERM CARE NETWORK
Entity Type:Organization
Organization Name:LONG TERM CARE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NERLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JESTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-460-2464
Mailing Address - Street 1:7025 COUNTY ROAD 46A STE 1071-134
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7025 COUNTY ROAD 46A STE 1071-134
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4721
Practice Address - Country:US
Practice Address - Phone:407-692-7999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty