Provider Demographics
NPI:1053528695
Name:AMONET HEALTHCARE
Entity type:Organization
Organization Name:AMONET HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:863-853-8484
Mailing Address - Street 1:3434 KNIGHTS STATION RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2517
Mailing Address - Country:US
Mailing Address - Phone:863-853-8484
Mailing Address - Fax:863-853-2944
Practice Address - Street 1:3434 KNIGHTS STATION RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-2517
Practice Address - Country:US
Practice Address - Phone:863-853-8484
Practice Address - Fax:863-853-2944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8544310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility