M-K of Haines City L L C

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1190095 Issued in FL

Legal business name

M-K OF HAINES CITY L L C

Practice address

409 S 10TH St
Haines City, FL 33844-5603

Phone

(863) 422-8656

Fax

(863) 422-8008

NPI assigned

Jul 6, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Tom Glass

Title

Administrator

Phone

(863) 422-8656

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237420800000",
    "number": "1154328102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 S 10TH ST",
            "city": "HAINES CITY",
            "state": "FL",
            "postal_code": "338445603",
            "telephone_number": "863-422-8656",
            "fax_number": "863-422-8008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 S 10TH ST",
            "city": "HAINES CITY",
            "state": "FL",
            "postal_code": "338445603",
            "telephone_number": "863-422-8656",
            "fax_number": "863-422-8008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M-K OF HAINES CITY L L C",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-06",
        "last_updated": "2009-03-19",
        "status": "A",
        "authorized_official_last_name": "GLASS",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "863-422-8656",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1190095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022434100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Athalia Leeanna Lopez, RN
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• Rachel Lubin
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• Jennea L Lyking, RN
• Isidro Tucker Madrid Jr.
• Fidencio Maldonado Rios
• Manuel G Jain, MD, LLC
• Makeia Keshon Martin
• Marisa Martin

• Skilled Nursing Facility in Haines City, FL
• Providers in Haines City, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.