Provider Demographics
NPI:1700020914
Name:RESTHAVEN OF HARDEE COUNTY INC
Entity Type:Organization
Organization Name:RESTHAVEN OF HARDEE COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN BOARD OF DIRECTORS
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LOIS
Authorized Official - Last Name:CRAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-773-6000
Mailing Address - Street 1:120 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUCHULA
Mailing Address - State:FL
Mailing Address - Zip Code:33873-2710
Mailing Address - Country:US
Mailing Address - Phone:863-773-2637
Mailing Address - Fax:
Practice Address - Street 1:298 RESTHAVEN RD
Practice Address - Street 2:
Practice Address - City:ZOLFO SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33890-9500
Practice Address - Country:US
Practice Address - Phone:863-773-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5073310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142410600Medicaid