Provider Demographics
NPI:1962777177
Name:SPIRIT ENTERPRISES
Entity type:Organization
Organization Name:SPIRIT ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1727-808-1093
Mailing Address - Street 1:86446 SAND HICKORY TRL
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-4297
Mailing Address - Country:US
Mailing Address - Phone:904-225-0771
Mailing Address - Fax:
Practice Address - Street 1:9035 BRIAN DAIRY ROAD
Practice Address - Street 2:LARGO HEALTH CENTER
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:32097
Practice Address - Country:US
Practice Address - Phone:727-395-9619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19623314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility