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NPI Code Detail

MEDICARE: WILDWOOD SNF LLC

MEDICARE: WILDWOOD SNF 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 FacilitySNF1588096FL

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 : 1770782583
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILDWOOD SNF LLC
Provider Business Mailing Address
First Line : 1835 NE MIAMI GARDENS DR
Second Line : #368
City : NORTH MIAMI BEACH
State : FL
Zip : 33179-5035
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 490 S OLD WIRE RD
Second Line :
City : WILDWOOD
State : FL
Zip : 34785-5001
Country : US
Telephone Number : 352-748-3322
Fax Number : 352-748-7609
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : MR. TZVI BOGOMILSKY
Credential :
Telephone Number : 305-401-7901
Provider Enumeration Date : 07/12/2007
Last Update Date : 10/04/2013

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