MEDICARE: LAKE WORTH SNF LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332BN1400X	Nursing Facility Supplies (DME)
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
3	314000000X	Skilled Nursing Facility

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861691693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE WORTH 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	:	1711 6TH AVE S
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-4333
Country	:	US
Telephone Number	:	561-586-0808
Fax Number	:	561-585-8757

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	:	07/10/2013

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Directions to “LAKE WORTH SNF LLC ” Practice Location

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