Provider Demographics
NPI:1730483827
Name:PLANTATION KEY OPERATING COMPANY, LLC
Entity Type:Organization
Organization Name:PLANTATION KEY OPERATING COMPANY, LLC
Other - Org Name:PLANTATION KEY NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-342-3155
Mailing Address - Street 1:1050 CHINOE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-6571
Mailing Address - Country:US
Mailing Address - Phone:859-255-0075
Mailing Address - Fax:858-254-7825
Practice Address - Street 1:48 HIGH POINT RD
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2006
Practice Address - Country:US
Practice Address - Phone:305-825-3021
Practice Address - Fax:305-852-2672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1446096OtherSTATE LICENSE
FL004497500Medicaid
FL004497500Medicaid