Eagle Lake Foundation Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF15650961 Issued in FL

Legal business name

EAGLE LAKE FOUNDATION INC

Doing business as

Eagle Lake Rehab & Care Center

Practice address

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

Phone

(727) 345-9331

Fax

(727) 345-7064

NPI assigned

Aug 3, 2006

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

VP of Acct & Finance

Phone

(727) 723-3000

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Eagle Lake Rehab & Care Center Doing business as

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288915200000",
    "number": "1225046584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24641 US HIGHWAY 19 N",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337635007",
            "telephone_number": "727-723-3000",
            "fax_number": "727-723-3076"
        },
        {
            "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 FOUNDATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2010-11-05",
        "status": "A",
        "authorized_official_last_name": "HEBBELN",
        "authorized_official_first_name": "LYNDA",
        "authorized_official_title_or_position": "VP OF ACCT & FINANCE",
        "authorized_official_telephone_number": "727-723-3000"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF15650961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "031106500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER #",
            "identifier": "L43",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagle Lake Rehab & Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Joy Dziopala, ARNP
• E & S Family Medicine Physicians
• E Therapy Staffing Solutions
• Eagle Lake Nursing & Rehab Opco LLC
• Eagle Lake Opco LLC
• Eagle Lake Rehab & Nursing LLC
• Eagle Lake Rehab & Nursing, LLC
• Jane Eagle

• Skilled Nursing Facility in St Petersburg, FL
• Providers in St Petersburg, 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 Nov 5, 2010; 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.