Provider Demographics
NPI:1699710186
Name:MLB JEFFERSONVILLE HEALTH FACILITIES, INC
Entity type:Organization
Organization Name:MLB JEFFERSONVILLE HEALTH FACILITIES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-635-9500
Mailing Address - Street 1:3922 COCONUT PALM DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-1388
Mailing Address - Country:US
Mailing Address - Phone:813-635-9500
Mailing Address - Fax:813-635-0081
Practice Address - Street 1:1720 E 8TH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-4659
Practice Address - Country:US
Practice Address - Phone:813-635-9500
Practice Address - Fax:813-635-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN155456Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER