Provider Demographics
NPI:1831798289
Name:SILOAM HEALTH CARE SERVICES
Entity type:Organization
Organization Name:SILOAM HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BERGELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEXIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-705-8054
Mailing Address - Street 1:1205 NEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-4144
Mailing Address - Country:US
Mailing Address - Phone:863-510-5921
Mailing Address - Fax:
Practice Address - Street 1:1205 NEVILLE AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4144
Practice Address - Country:US
Practice Address - Phone:863-510-5921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-17
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility