Provider Demographics
NPI:1154873149
Name:RSC DUNNELLON HARBOR LLC
Entity type:Organization
Organization Name:RSC DUNNELLON HARBOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-613-2300
Mailing Address - Street 1:12080 SW HIGHWAY 484
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432
Mailing Address - Country:US
Mailing Address - Phone:954-613-2300
Mailing Address - Fax:954-613-2301
Practice Address - Street 1:12080 SW HIGHWAY 484
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432
Practice Address - Country:US
Practice Address - Phone:954-613-2300
Practice Address - Fax:954-613-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8142310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL8142OtherAHCA