Provider Demographics
NPI:1982601670
Name:HEATHER HILL NURSING CENTER LLC
Entity Type:Organization
Organization Name:HEATHER HILL NURSING CENTER LLC
Other - Org Name:HEATHER HILL HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ALMA
Authorized Official - Last Name:OWENS-WICKER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:727-849-6939
Mailing Address - Street 1:6630 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-2712
Mailing Address - Country:US
Mailing Address - Phone:727-849-6939
Mailing Address - Fax:727-843-0262
Practice Address - Street 1:6630 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-2712
Practice Address - Country:US
Practice Address - Phone:727-849-6939
Practice Address - Fax:727-843-0262
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH SERVICES MANAGEMENT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-07
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1217096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK62OtherBC/BS SKILLED NURSING FAC
FL3926720001OtherDMEPOS SKILLED NURSING
FLK62OtherBC/BS SKILLED NURSING FAC