Organization
MK OF WINTER GARDEN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TARRY HARBILAS (ADMINISTRATOR)
(407) 877-6636
Entity
Organization
Contact information
Practice address
12751 W COLONIAL DR, WINTER GARDEN, FL 34787-4113
(407) 877-6636
Mailing address
12751 W COLONIAL DR, WINTER GARDEN, FL 34787-4113
(407) 877-6636
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF1456096
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02254100
—
FL
Enumeration date
08/07/2006
Last updated
07/24/2008
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