Basic Information
| Provider Information | |||||||||
| NPI: | 1437698396 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RSC PEMBROKE PLAZA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PLAZA OF PEMBROKE PARK | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2870 STIRLING RD | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330201109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546132300 | ||||||||
| FaxNumber: | 9546132301 | ||||||||
| Practice Location | |||||||||
| Address1: | 3535 SW 52ND AVE | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330235420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549618111 | ||||||||
| FaxNumber: | 9546132301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2017 | ||||||||
| LastUpdateDate: | 02/13/2017 | ||||||||
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| AuthorizedOfficialLastName: | JORDAN | ||||||||
| AuthorizedOfficialFirstName: | GEREMY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9546132300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | FL | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.