Provider Demographics
NPI:1013134287
Name:SHCC SERVICES INC
Entity Type:Organization
Organization Name:SHCC SERVICES INC
Other - Org Name:FLORIDA LIVING NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP CFO
Authorized Official - Prefix:MISS
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEHTJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-975-3010
Mailing Address - Street 1:602 COURTLAND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-1360
Mailing Address - Country:US
Mailing Address - Phone:407-975-3000
Mailing Address - Fax:407-975-3090
Practice Address - Street 1:3355 E SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-6062
Practice Address - Country:US
Practice Address - Phone:407-862-6263
Practice Address - Fax:407-862-4188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF11550962314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105353Medicare Oscar/Certification
FL3770900003Medicare NSC