Eagle Lake Rehab & Nursing, LLC

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

SNF15650961 Issued in FL

Legal business name

EAGLE LAKE REHAB & NURSING, LLC

Practice address

1100 66TH St N
St Petersburg, FL 33710-6224

Phone

(727) 345-9331

Fax

(727) 345-7064

NPI assigned

Mar 16, 2012

Organization subpart

No

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

Authorized official

Name

Lynda Hebbeln

Title

Cfo

Phone

(727) 723-3021

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1331856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334880000000",
    "number": "1174898605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 66TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337106224",
            "telephone_number": "727-345-9331",
            "fax_number": "727-345-7064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 66TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337106224",
            "telephone_number": "727-345-9331",
            "fax_number": "727-345-7064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE LAKE REHAB & NURSING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-16",
        "last_updated": "2012-04-20",
        "status": "A",
        "authorized_official_last_name": "HEBBELN",
        "authorized_official_first_name": "LYNDA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "727-723-3021"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "FL",
            "license": "SNF15650961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• E Therapy Staffing Solutions
• Eagle Lake Foundation Inc
• Eagle Lake Nursing & Rehab Opco LLC
• Eagle Lake Opco LLC
• Eagle Lake Rehab & Nursing LLC
• Jane Eagle
• Joanne Eames, APRN
• Ashley Maria Eardley
• Jordan E Earle, LCSW
• Leigh C Earle, M.A., CCC

• Nursing Facility/Intermediate Care Facility in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Nursing Facility/Intermediate Care Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2012; 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.