EAGLE LAKE FOUNDATION INC (NPI# 1225046584) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225046584 |
| Entity Type | Organization |
| Organization Name | EAGLE LAKE FOUNDATION INC |
| Other Organization Name | EAGLE LAKE REHAB & CARE CENTER |
| Practice Address |
1100 66th St N St Petersburg FL 33710-6224 |
| Mailing Address |
24641 Us Highway 19 N Clearwater FL 33763-5007 |
| Practice Telephone | 7273459331 |
| Practice Fax Number | 7273457064 |
| Mailing Telephone | 7277233000 |
| Mailing Fax Number | 7277233076 |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2010-11-05 |
| Authorized Official Name | LYNDA HEBBELN (VP OF ACCT & FINANCE) |
| Authorized Official Telephone | 7277233000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | SNF15650961 | FL | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BLUE CROSS PROVIDER # | L43 | 01 |
| FL | 031106500 | 05 |
| Other Name | Type Code |
|---|---|
| Eagle Lake Rehab & Care Center | Doing Business As Name - Organization |
| Street Address |
1100 66TH ST N |
| City | ST PETERSBURG |
| State | FL |
| Zip Code | 33710-6224 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1174898605 | Eagle Lake Rehab & Nursing, LLC | Nursing Facility/Intermediate Care Facility | 1100 66th St N, St Petersburg, FL 33710-6224 | 2012-03-16 |
| 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 | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134138985 | Coquina Key Health Care Center, Inc. | Skilled Nursing Facility | 435 42nd Ave S, St Petersburg, FL 33705-4504 | 2006-08-07 |
| 1467488981 | Suncoast Manor Retirement Community, Inc. | Skilled Nursing Facility | 1095 Pinellas Point Dr S, St Petersburg, FL 33705-6154 | 2006-06-25 |
| 1295723591 | Senior Care Golfview LLC | Skilled Nursing Facility | 3636 10th Ave N, St Petersburg, FL 33713-6528 | 2005-10-11 |
| 1225026818 | Saint Petersburg Snf LLC | Skilled Nursing Facility | 811 Jackson St N, St Petersburg, FL 33705-1238 | 2005-10-09 |
| 1013904234 | Bon Secours - Maria Manor Nursing Care Center LLC | Skilled Nursing Facility | 10300 4th St North, St Petersburg, FL 33716-3810 | 2005-10-03 |
| 1295722817 | Sovereign Healthcare of Pinellas Point, LLC | Skilled Nursing Facility | 5601 31st St S, St Petersburg, FL 33712-4605 | 2005-09-29 |
| 1740276385 | Snell Island Snf LLC | Skilled Nursing Facility | 4500 Indianapolis St Ne, St Petersburg, FL 33703-4317 | 2005-09-20 |
| 1811999881 | Scg Baywood LLC | Skilled Nursing Facility | 2000 17th Ave S, St Petersburg, FL 33712 | 2005-08-10 |
| 1932101987 | Scg Laurellwood LLC | Skilled Nursing Facility | 3127 57th Ave N, St Petersburg, FL 33714 | 2005-08-10 |
| 1134125362 | Sa-st. Petersburg, LLC | Skilled Nursing Facility | 521 69th Ave N, St Petersburg, FL 33702-6810 | 2005-06-22 |
| Find all providers in ST PETERSBURG | ||||
| City | ST PETERSBURG |
| Zip Code | 33710 |
Please comment or provide details below to improve the information on EAGLE LAKE FOUNDATION INC.
| 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.