Provider Demographics
NPI:1790731594
Name:PLANTATION BAY HEALTH CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:PLANTATION BAY HEALTH CARE ASSOCIATES LLC
Other - Org Name:PLANTATION BAY REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-892-7344
Mailing Address - Street 1:4641 OLD CANOE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-1550
Mailing Address - Country:US
Mailing Address - Phone:407-892-7344
Mailing Address - Fax:407-892-5244
Practice Address - Street 1:4641 OLD CANOE CREEK RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-1550
Practice Address - Country:US
Practice Address - Phone:407-892-7344
Practice Address - Fax:407-892-5244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF16340962314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025244100Medicaid
FL025244100Medicaid