Provider Demographics
NPI:1902429590
Name:PORT CHARLOTTE HMA LLC
Entity Type:Organization
Organization Name:PORT CHARLOTTE HMA LLC
Other - Org Name:SHOREPOINT HEALTH PORT CHARLOTTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:2500 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5000
Mailing Address - Country:US
Mailing Address - Phone:941-766-4122
Mailing Address - Fax:941-766-4101
Practice Address - Street 1:2500 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5000
Practice Address - Country:US
Practice Address - Phone:941-766-4122
Practice Address - Fax:941-766-4101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PORT CHARLOTTE HMA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-19
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit