Provider Demographics
NPI:1578726964
Name:BILL'S PLACE
Entity Type:Organization
Organization Name:BILL'S PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:SWARTOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-291-1962
Mailing Address - Street 1:4860 CHICKPEA ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-5957
Mailing Address - Country:US
Mailing Address - Phone:904-291-1962
Mailing Address - Fax:
Practice Address - Street 1:4860 CHICKPEA ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-5957
Practice Address - Country:US
Practice Address - Phone:904-291-1962
Practice Address - Fax:904-291-1962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6905291311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL141503400Medicaid