Provider Demographics
NPI:1851553317
Name:PENDRY ESTATE
Entity Type:Organization
Organization Name:PENDRY ESTATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-357-2268
Mailing Address - Street 1:36120 HUFF RD
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32736-9335
Mailing Address - Country:US
Mailing Address - Phone:352-357-2268
Mailing Address - Fax:352-357-2065
Practice Address - Street 1:36120 HUFF RD
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32736-9335
Practice Address - Country:US
Practice Address - Phone:352-357-2268
Practice Address - Fax:352-357-2065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906206311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home