Provider Demographics
NPI:1285991265
Name:PENNEY RETIREMENT COMMUNITY, INC.
Entity type:Organization
Organization Name:PENNEY RETIREMENT COMMUNITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ENGELKES
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:904-284-8582
Mailing Address - Street 1:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:PENNEY FARMS
Mailing Address - State:FL
Mailing Address - Zip Code:32079-0555
Mailing Address - Country:US
Mailing Address - Phone:904-284-8582
Mailing Address - Fax:904-284-6259
Practice Address - Street 1:1 PAVILION PLACE
Practice Address - Street 2:
Practice Address - City:PENNEY FARMS
Practice Address - State:FL
Practice Address - Zip Code:32079-0555
Practice Address - Country:US
Practice Address - Phone:904-284-8582
Practice Address - Fax:904-284-6259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1325096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility