Basic Information
| Provider Information | |||||||||
| NPI: | 1760499404 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOBE SOUND GERIATRIC VILLAGE, INC. | ||||||||
| LastName: | |||||||||
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| MiddleName: | |||||||||
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| OtherOrganizationName: | EDGEWATER MANOR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11700 E 10 MILE RD | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480893903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867595966 | ||||||||
| FaxNumber: | 5867598006 | ||||||||
| Practice Location | |||||||||
| Address1: | 9555 SE FEDERAL HWY | ||||||||
| Address2: | |||||||||
| City: | HOBE SOUND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334552009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7725465800 | ||||||||
| FaxNumber: | 7725466567 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BORTZ | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5867595966 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 13200961 | FL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.