MEDICARE: SOUTH BROWARD HOSPITAL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	SNF1342096	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114920584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH BROWARD HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	777 S DOUGLAS RD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33025-1353
Country	:	US
Telephone Number	:	954-431-1100
Fax Number	:	954-443-4798

Provider Business Practice Location Address
First Line	:	777 S DOUGLAS RD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33025-1353
Country	:	US
Telephone Number	:	954-431-1100
Fax Number	:	954-443-4798

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JON HENNEMYRE
Credential	:	NHA
Telephone Number	:	954-276-6201

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	01/23/2019

Similar Medicare Providers

1386988806 — SOUTH BROWARD HOSPITAL DISTRICT
Practice Location Address:

777 S DOUGLAS RD
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1164904918 — JASNIELKA VALDEZ MS, OTR/L
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1467954198 — HR MEDICAL GROUP INC
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1396237947 — AURELIE JEAN-LOUIS
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Practice Location Address:

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Directions to “SOUTH BROWARD HOSPITAL DISTRICT ” Practice Location

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