Provider Demographics
NPI:1720467210
Name:SUNCOAST MANOR RETIREMENT COMMUNITY INC
Entity Type:Organization
Organization Name:SUNCOAST MANOR RETIREMENT COMMUNITY INC
Other - Org Name:WESTMINSTER SUNCOAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VICE PRESIDENT & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:T
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:407-839-5050
Mailing Address - Street 1:1095 PINELLAS POINT DR S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-6154
Mailing Address - Country:US
Mailing Address - Phone:727-867-1131
Mailing Address - Fax:727-866-8742
Practice Address - Street 1:1095 PINELLAS POINT DR S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-6154
Practice Address - Country:US
Practice Address - Phone:727-867-1131
Practice Address - Fax:727-866-8742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL6535310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021270900Medicaid
FL105926Medicare PIN