Provider Demographics
NPI:1679629133
Name:ANDERSON-HEIDEL PROPERTIES,LLC
Entity Type:Organization
Organization Name:ANDERSON-HEIDEL PROPERTIES,LLC
Other - Org Name:RAEFORD MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-809-6531
Mailing Address - Street 1:5824 BEE RIDGE RD # 287
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5065
Mailing Address - Country:US
Mailing Address - Phone:947-809-6531
Mailing Address - Fax:
Practice Address - Street 1:5824 BEE RIDGE RD # 287
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5065
Practice Address - Country:US
Practice Address - Phone:947-809-6531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7804771310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804771Medicaid