Provider Demographics
NPI:1770579906
Name:PHI LLC
Entity type:Organization
Organization Name:PHI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:DENHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:727-548-5566
Mailing Address - Street 1:6767 86TH AVE NORTH
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-4597
Mailing Address - Country:US
Mailing Address - Phone:727-548-5566
Mailing Address - Fax:727-548-6644
Practice Address - Street 1:6767 86TH AVE NORTH
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-4597
Practice Address - Country:US
Practice Address - Phone:727-548-5566
Practice Address - Fax:727-548-6644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF130470981314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35960917OtherSTATE FACILITY MDS ID NUM
FL026435100Medicaid
FL35960917OtherSTATE FACILITY MDS ID NUM