Provider Demographics
NPI:1083263040
Name:ESKRIDGE OPERATOR, LLC
Entity type:Organization
Organization Name:ESKRIDGE OPERATOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-280-1333
Mailing Address - Street 1:2907 W BAY TO BAY BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-8187
Mailing Address - Country:US
Mailing Address - Phone:813-280-1333
Mailing Address - Fax:
Practice Address - Street 1:505 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ESKRIDGE
Practice Address - State:KS
Practice Address - Zip Code:66423-9646
Practice Address - Country:US
Practice Address - Phone:785-449-2294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSN099002OtherKANSAS STATE LICENSE NUMBER