Organization
PL NURSING CENTER LLC
Active
Other names
Pine Lake Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
NELSON ROBAINA (VP OF REIMBURSEMENT)
(305) 864-9191
Entity
Organization
Contact information
Practice address
13455 W US 90, GREENVILLE, FL 32331-4318
(850) 948-4601
Mailing address
13455 W US 90, GREENVILLE, FL 32331-4318
(850) 948-4601
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF1438096
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021401900
—
FL
Enumeration date
05/21/2008
Last updated
05/21/2008
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