Basic Information
| Provider Information | |||||||||
| NPI: | 1174269633 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HCR MANOR CARE SERVICES OF FLORIDA III, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10086 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436990086 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 134 S DIXIE HWY STE 207 | ||||||||
| Address2: | |||||||||
| City: | HALLANDALE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330095434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544677423 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2022 | ||||||||
| LastUpdateDate: | 05/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | ALLEN | ||||||||
| AuthorizedOfficialFirstName: | MARTIN | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4192525734 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HCR MANOR CARE SERVICES OF FLORIDA III, LLC | ||||||||
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| NPICertificationDate: | 05/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.