Organization
M-K OF HAINES CITY L L C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TOM GLASS (ADMINISTRATOR)
(863) 422-8656
Entity
Organization
Contact information
Practice address
409 S 10TH ST, HAINES CITY, FL 33844-5603
(863) 422-8656
(863) 422-8008
Mailing address
409 S 10TH ST, HAINES CITY, FL 33844-5603
(863) 422-8656
(863) 422-8008
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF1190095
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022434100
—
FL
Enumeration date
07/06/2005
Last updated
03/19/2009
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