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NPI Code Detail

MEDICARE: BROOKSVILLE HEALTH CARE CENTER LLC

MEDICARE: BROOKSVILLE HEALTH CARE CENTER LLC
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
1314000000XSkilled Nursing FacilitySNF 1063096FL

Other Identifiers

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

General Provider Information

NPI Number : 1497750954
Entity Type Code : Organization
Provider Name (Legal Business Name) : BROOKSVILLE HEALTH CARE CENTER LLC
Provider Business Mailing Address
First Line : 1114 CHATMAN BLVD
Second Line :
City : BROOKSVILLE
State : FL
Zip : 34601-3104
Country : US
Telephone Number : 352-796-6701
Fax Number : 352-796-6514
Provider Business Practice Location Address
First Line : 1114 CHATMAN BLVD
Second Line :
City : BROOKSVILLE
State : FL
Zip : 34601-3104
Country : US
Telephone Number : 352-796-6701
Fax Number : 352-796-6514
Authorized Official
Title or Position : ADMINISTRATOR
Name : MS. WANDA MOAK
Credential :
Telephone Number : 352-796-6701
Provider Enumeration Date : 06/20/2005
Last Update Date : 02/07/2008

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Directions to “BROOKSVILLE HEALTH CARE CENTER LLC ” Practice Location

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