Basic Information
| Provider Information | |||||||||
| NPI: | 1477621589 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NURSING HOME DIVERSION AMERICAN ELDERCARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14565 SIMS RD | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334848549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614964440 | ||||||||
| FaxNumber: | 5618608607 | ||||||||
| Practice Location | |||||||||
| Address1: | 14565 SIMS RD | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334848547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614999656 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 09/07/2011 | ||||||||
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| AuthorizedOfficialLastName: | SCHEMEL | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5614999656 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | N | Agencies | Home Health | 302R00000X | 299991930 | FL | N | Managed Care Organizations | Health Maintenance Organization | 302R00000X | 299991713 | FL | N | Managed Care Organizations | Health Maintenance Organization | 302R00000X | 299991915 | FL | Y | Managed Care Organizations | Health Maintenance Organization |
ID Information
| ID | Type | State | Issuer | Description | 015031220 | 05 | FL | MEDICAID | 015031227 | 05 | FL | MEDICAID | 015031234 | 05 | FL | MEDICAID | 015031237 | 05 | FL | MEDICAID | 015031223 | 05 | FL | MEDICAID | 015031231 | 05 | FL | MEDICAID | 015031233 | 05 | FL | MEDICAID | 015031221 | 05 | FL | MEDICAID | 015031222 | 05 | FL | MEDICAID | 015031228 | 05 | FL | MEDICAID | 015031230 | 05 | FL | MEDICAID | 015031235 | 05 | FL | MEDICAID | 015031232 | 05 | FL | MEDICAID | 015031229 | 05 | FL | MEDICAID | 015031224 | 05 | FL | MEDICAID | 015031226 | 05 | FL | MEDICAID | 015031236 | 05 | FL | MEDICAID | 015031225 | 05 | FL | MEDICAID |