Provider Demographics
NPI:1871025452
Name:GLORIA'S PLACE ON THE HARBOR I
Entity Type:Organization
Organization Name:GLORIA'S PLACE ON THE HARBOR I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:727-643-8050
Mailing Address - Street 1:1710 HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-1825
Mailing Address - Country:US
Mailing Address - Phone:727-643-8050
Mailing Address - Fax:
Practice Address - Street 1:1710 HARBOR DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-1825
Practice Address - Country:US
Practice Address - Phone:727-643-8050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-01
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906897311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home