Basic Information
Provider Information | |||||||||
NPI: | 1295781870 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | AYERS HEALTH & REHABILITATION CENTER, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 606 NE 7TH ST | ||||||||
Address2: |   | ||||||||
City: | TRENTON | ||||||||
State: | FL | ||||||||
PostalCode: | 326933636 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3524637101 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 606 NE 7TH ST | ||||||||
Address2: |   | ||||||||
City: | TRENTON | ||||||||
State: | FL | ||||||||
PostalCode: | 326933636 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3524637101 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/25/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SWEENEY | ||||||||
AuthorizedOfficialFirstName: | MARSHALL | ||||||||
AuthorizedOfficialMiddleName: | PRESTON | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 6158961191 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | SNF1337096 | FL | Y |   | Nursing & Custodial Care Facilities | Skilled Nursing Facility |   |
ID Information
ID | Type | State | Issuer | Description | 14801 | 01 |   | STAY WELL | OTHER | M30 | 01 | FL | BCBS FL | OTHER | 101974 | 01 |   | AVMED | OTHER |