EAGLE LAKE REHAB & NURSING, LLC (NPI# 1174898605) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174898605 |
| Entity Type | Organization |
| Organization Name | EAGLE LAKE REHAB & NURSING, LLC |
| Practice Address |
1100 66th St N St Petersburg FL 33710-6224 |
| Practice Telephone | 7273459331 |
| Practice Fax Number | 7273457064 |
| Mailing Telephone | 7273459331 |
| Mailing Fax Number | 7273457064 |
| Enumeration Date | 2012-03-16 |
| Last Update Date | 2012-04-20 |
| Authorized Official Name | LYNDA HEBBELN (CFO) |
| Authorized Official Telephone | 7277233021 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 313M00000X | Nursing Facility/Intermediate Care Facility | SNF15650961 | FL | Nursing & Custodial Care Facilities |
| Street Address |
1100 66TH ST N |
| City | ST PETERSBURG |
| State | FL |
| Zip Code | 33710-6224 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225046584 | Eagle Lake Foundation Inc | Skilled Nursing Facility | 1100 66th St N, St Petersburg, FL 33710-6224 | 2006-08-03 |
| 1154787141 | Blue Ridge By The Lake LLC | Skilled Nursing Facility | 1100 66th St N, St Petersburg, FL 33710-6224 | 2016-01-07 |
| 1164798104 | Eagle Lake Rehab & Nursing LLC | Skilled Nursing Facility | 1100 66th St N, St Petersburg, FL 33710-6224 | 2012-03-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023615812 | Bay Vision Inc | Optometrist | 6951 22nd Ave North, St. Petersburg, FL 33710 | 2020-10-05 |
| 1821566845 | Harish J. Patel, Md | Non-Pharmacy Dispensing Site | 6449 38th Avenue North, Suite B3, Saint Petersburg, FL 33710 | 2018-11-07 |
| 1659860708 | Lydia M Gomez | Physical Therapist | 6775 Crosswinds Dr. N, Saint Petersburg, FL 33710 | 2018-05-04 |
| 1619498169 | Tiffiny C Rudkin | Massage Therapist | 3039 - 49th St. N., St. Petersburg, FL 33710 | 2017-07-05 |
| 1114456480 | Roberto Macedo Dentistry LLC | Dentist | 7801 38th Ave North, St. Petersburg, FL 33710 | 2017-06-08 |
| 1528429495 | Frank Michael Massotto Jr. | Nurse Practitioner | 3251 66th St. North, St Petersburg, FL 33710 | 2016-03-18 |
| 1235522889 | Toby Weinman Assisted Living Residence | Assisted Living Facility | 240 59th St N, St Petersburg, FL 33710 | 2015-03-06 |
| 1821415951 | Ryan Troup | Physician Assistant | 603 - 7th St. S, Suite 360, Emergency Physicians of Saint Petersburg, Saint Petersburg, FL 33710 | 2014-03-26 |
| 1629491600 | Garett Janes Sears | Psychologist | 1913 Tyrone Blvd, St. Petersburg, FL 33710 | 2014-01-28 |
| 1912331943 | Solimar Jimenez Diaz | Obstetrics & Gynecology | 6450 38th Ave N Ste 200, St Petersburg, FL 33710 | 2013-08-27 |
| Find all providers in zip 33710 | ||||
| Taxonomy Code | 313M00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Nursing Facility/Intermediate Care Facility |
| An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. |
| Notes: Source: Paraphrased from Section 1919 (a) of the Social Security Act. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659694321 | Lp St. Petersburg, LLC | Nursing Facility/Intermediate Care Facility | 3636 10th Ave N, St Petersburg, FL 33713-6528 | 2010-03-09 |
| 1386868594 | Baywood Nursing Center, Inc | Nursing Facility/Intermediate Care Facility | 2000 17th Ave S, St Petersburg, FL 33712-2714 | 2007-04-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962021550 | Lighthouz Home Health Care LLC | Nursing Facility/Intermediate Care Facility | 6418 Seabury Way, Orlando, FL 32818-1750 | 2020-04-13 |
| 1902263007 | Marie E. Simeon | Nursing Facility/Intermediate Care Facility | 8206 Pennywell Place, Tampa, FL 33615 | 2016-01-20 |
| 1861895476 | Miami Va Health Care System | Nursing Facility/Intermediate Care Facility | 8765 Sw 146th St, Palmetto Bay, FL 33176-8083 | 2014-09-28 |
| 1578977799 | A Labor of Love Doula Services LLC | Nursing Facility/Intermediate Care Facility | 12311 164th Ct N, Jupiter, FL 33478-6568 | 2014-06-16 |
| 1962812545 | Florida Presbyterian Homes, Inc | Nursing Facility/Intermediate Care Facility | 901 Lakeside Avenue, Lakeland, FL 33803 | 2014-05-05 |
| 1013336346 | Bonaventure Health Services Inc. | Nursing Facility/Intermediate Care Facility | 123 Nw 13th St Ste 214-05, Boca Raton, FL 33432-1641 | 2014-04-15 |
| 1295153716 | Jeffrey D Mandelkorn Phd Pa | Nursing Facility/Intermediate Care Facility | 2000 Ne 17th St, #3, Fort Lauderdale, FL 33305-2565 | 2014-04-01 |
| 1801212097 | Faith Home Care Alf Inc. | Nursing Facility/Intermediate Care Facility | 114 Euclid Ave, Seffner, FL 33584-8000 | 2014-03-12 |
| 1295150712 | Happy Living LLC | Nursing Facility/Intermediate Care Facility | 582 Koala Dr, Kissimmee, FL 34759-4210 | 2014-02-19 |
| 1902243207 | Senior Home Maker Companion | Nursing Facility/Intermediate Care Facility | 13440 Sw 36 St, Miami, FL 33175 | 2013-05-28 |
| Find all providers with the same taxonomy | ||||
| City | ST PETERSBURG |
| Zip Code | 33710 |
Please comment or provide details below to improve the information on EAGLE LAKE REHAB & NURSING, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.