Provider Demographics
NPI:1770568917
Name:IHS ACQUISITION NO 103 INC
Entity type:Organization
Organization Name:IHS ACQUISITION NO 103 INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRYBUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-539-2354
Mailing Address - Street 1:1350 S NOVA RD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-5812
Mailing Address - Country:US
Mailing Address - Phone:386-258-5544
Mailing Address - Fax:386-255-5623
Practice Address - Street 1:1350 S NOVA RD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5812
Practice Address - Country:US
Practice Address - Phone:386-258-5544
Practice Address - Fax:386-255-5623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1164095314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL223905Medicaid
FL223905Medicaid