Provider Demographics
NPI:1760081749
Name:HSRE-AHR ZEPHYRHILLS LLC
Entity Type:Organization
Organization Name:HSRE-AHR ZEPHYRHILLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:STODULSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-784-6550
Mailing Address - Street 1:38130 PRETTY POND ROAD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33540
Mailing Address - Country:US
Mailing Address - Phone:813-779-4501
Mailing Address - Fax:813-779-4509
Practice Address - Street 1:38130 PRETTY POND ROAD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540
Practice Address - Country:US
Practice Address - Phone:813-779-4501
Practice Address - Fax:813-779-4509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility