Provider Demographics
NPI:1578320172
Name:EAGLE LAKE NURSING & REHAB OPCO LLC
Entity Type:Organization
Organization Name:EAGLE LAKE NURSING & REHAB OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:EDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAJMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-785-9156
Mailing Address - Street 1:7951 SW 6TH ST STE 116
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3211
Mailing Address - Country:US
Mailing Address - Phone:786-785-9165
Mailing Address - Fax:
Practice Address - Street 1:1100 66TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-6224
Practice Address - Country:US
Practice Address - Phone:727-345-9331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility