Provider Demographics
NPI:1912924952
Name:SYLVAN HEALTH SYSTEMS LLC
Entity Type:Organization
Organization Name:SYLVAN HEALTH SYSTEMS LLC
Other - Org Name:SYLVAN HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:BREDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED NHA
Authorized Official - Phone:727-791-1500
Mailing Address - Street 1:2770 REGENCY OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1509
Mailing Address - Country:US
Mailing Address - Phone:727-791-1500
Mailing Address - Fax:727-791-7743
Practice Address - Street 1:2770 REGENCY OAKS BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1509
Practice Address - Country:US
Practice Address - Phone:727-791-1500
Practice Address - Fax:727-791-7743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL105314000000X
FL022314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022916400Medicaid
FL105744Medicare Oscar/Certification