Provider Demographics
NPI:1962812545
Name:FLORIDA PRESBYTERIAN HOMES, INC
Entity type:Organization
Organization Name:FLORIDA PRESBYTERIAN HOMES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HEHN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:863-577-6033
Mailing Address - Street 1:16 LAKE HUNTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803
Mailing Address - Country:US
Mailing Address - Phone:863-688-5521
Mailing Address - Fax:863-687-4088
Practice Address - Street 1:901 LAKESIDE AVENUE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803
Practice Address - Country:US
Practice Address - Phone:863-688-5521
Practice Address - Fax:863-687-4088
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA PRESBYTERIAN HOMES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL4790313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility