Provider Demographics
NPI:1699281337
Name:ST MARK VILLAGE INC
Entity type:Organization
Organization Name:ST MARK VILLAGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POHL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:727-785-2577
Mailing Address - Street 1:2655 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-2630
Mailing Address - Country:US
Mailing Address - Phone:727-785-2577
Mailing Address - Fax:727-786-6835
Practice Address - Street 1:880 HIGHLANDS BLVD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2827
Practice Address - Country:US
Practice Address - Phone:727-785-2577
Practice Address - Fax:727-786-6835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7369310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility