Provider Demographics
NPI:1306169156
Name:LP HOLLYWOOD, LLC
Entity type:Organization
Organization Name:LP HOLLYWOOD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-568-7800
Mailing Address - Street 1:600 N 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4606
Mailing Address - Country:US
Mailing Address - Phone:954-927-2531
Mailing Address - Fax:954-927-0425
Practice Address - Street 1:600 N 17TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4606
Practice Address - Country:US
Practice Address - Phone:954-927-2531
Practice Address - Fax:954-927-0425
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LP O HOLDINGS II, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-09
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF11760963313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
10-5009Medicare UPIN