Provider Demographics
NPI:1619446341
Name:FAMILY EXTENDED CARE OF SPRING HILL NW, INC.
Entity Type:Organization
Organization Name:FAMILY EXTENDED CARE OF SPRING HILL NW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-728-1534
Mailing Address - Street 1:11291 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5616
Mailing Address - Country:US
Mailing Address - Phone:352-799-1422
Mailing Address - Fax:
Practice Address - Street 1:11291 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5616
Practice Address - Country:US
Practice Address - Phone:353-799-1422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-26
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility