Provider Demographics
NPI:1487640389
Name:MEASE LIFE INC
Entity Type:Organization
Organization Name:MEASE LIFE INC
Other - Org Name:THE CEDAR AT MEASE LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-738-3209
Mailing Address - Street 1:700 MEASE PLZ
Mailing Address - Street 2:FINANCE
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-6680
Mailing Address - Country:US
Mailing Address - Phone:727-738-3000
Mailing Address - Fax:727-738-3306
Practice Address - Street 1:910 NEW YORK AVE
Practice Address - Street 2:FINANCE
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-6600
Practice Address - Country:US
Practice Address - Phone:727-733-1161
Practice Address - Fax:727-733-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF13350961314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020407200Medicaid
FLK7ROtherBLUE CROSS & BLUE SHIELD