Provider Demographics
NPI:1770689887
Name:CARPENTERS HOME ESTATES INC
Entity Type:Organization
Organization Name:CARPENTERS HOME ESTATES INC
Other - Org Name:THE ESTATES AT CARPENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-858-3847
Mailing Address - Street 1:1001 CARPENTERS WAY
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-3956
Mailing Address - Country:US
Mailing Address - Phone:863-858-3847
Mailing Address - Fax:863-859-7425
Practice Address - Street 1:1001 CARPENTERS WAY
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-3956
Practice Address - Country:US
Practice Address - Phone:863-858-3847
Practice Address - Fax:863-859-7425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1075096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105660Medicare ID - Type Unspecified