Organization
EAGLE LAKE FOUNDATION INC
Active
Other names
Eagle Lake Rehab & Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
LYNDA HEBBELN (VP OF ACCT & FINANCE)
(727) 723-3000
Entity
Organization
Contact information
Practice address
1100 66TH ST N, ST PETERSBURG, FL 33710-6224
(727) 345-9331
(727) 345-7064
Mailing address
24641 US HIGHWAY 19 N, CLEARWATER, FL 33763-5007
(727) 723-3000
(727) 723-3076
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF15650961
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031106500
—
FL
01
—
L43
BLUE CROSS PROVIDER #
FL
Enumeration date
08/03/2006
Last updated
11/05/2010
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