Provider Demographics
NPI:1922430354
Name:PHI 413, INC DBA GOOD SAMARITAN RETIREMENT HOME
Entity Type:Organization
Organization Name:PHI 413, INC DBA GOOD SAMARITAN RETIREMENT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARILOU
Authorized Official - Middle Name:
Authorized Official - Last Name:ZANANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-235-5961
Mailing Address - Street 1:5626 OXFORD MOOR BLVD
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-7009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:507 SE 1ST AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-2703
Practice Address - Country:US
Practice Address - Phone:352-528-3201
Practice Address - Fax:352-528-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL25310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility