Provider Demographics
NPI:1831433531
Name:FLORIDA PH-I, LLC
Entity type:Organization
Organization Name:FLORIDA PH-I, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST TREASURER/DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:FEKETE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-577-6040
Mailing Address - Street 1:16 LAKE HUNTER DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-1297
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 LAKE HUNTER DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-1297
Practice Address - Country:US
Practice Address - Phone:863-577-6040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA PRESBYTERIAN HOMES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL4790310400000X
FLSNF130470964314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility