Provider Demographics
NPI:1619603248
Name:PORT CHARLOTTE CARE CENTER LLC
Entity Type:Organization
Organization Name:PORT CHARLOTTE CARE CENTER LLC
Other - Org Name:CHARLOTTE BAY REHAB AND CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-705-6740
Mailing Address - Street 1:4033 BEAVER LN
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4033 BEAVER LN
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9206
Practice Address - Country:US
Practice Address - Phone:941-624-2358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14510962OtherLICENSE