Provider Demographics
NPI:1871610626
Name:HIGHLAND PINES REHABILITATION AND NURSING CENTER, LLC
Entity type:Organization
Organization Name:HIGHLAND PINES REHABILITATION AND NURSING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-446-0581
Mailing Address - Street 1:1111 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4432
Mailing Address - Country:US
Mailing Address - Phone:727-446-0581
Mailing Address - Fax:727-442-9425
Practice Address - Street 1:1111 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4432
Practice Address - Country:US
Practice Address - Phone:727-446-0581
Practice Address - Fax:727-442-9425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID NUMBER
FL105690Medicare ID - Type UnspecifiedMCR PROVIDER NUMBER