Provider Demographics
NPI:1194751610
Name:PRESBYTERIAN RETIREMENT COMMUNITIES, INC.
Entity type:Organization
Organization Name:PRESBYTERIAN RETIREMENT COMMUNITIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:T
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-839-5050
Mailing Address - Street 1:80 W LUCERNE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3779
Mailing Address - Country:US
Mailing Address - Phone:407-839-5050
Mailing Address - Fax:407-849-1718
Practice Address - Street 1:4449 MEANDERING WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5740
Practice Address - Country:US
Practice Address - Phone:850-878-1136
Practice Address - Fax:850-942-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1599096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1222930004OtherDMERC SUPPLIER NUMBER
FL105854Medicare ID - Type Unspecified