Healthcare Provider Details

I. General information

NPI: 1902180847
Provider Name (Legal Business Name): ESRHC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 VILLA DR
DAPHNE AL
36526-4653
US

IV. Provider business mailing address

3389 SHERIDAN ST SUITE 416
HOLLYWOOD FL
33021-3606
US

V. Phone/Fax

Practice location:
  • Phone: 251-626-2694
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN0204
License Number StateAL

VIII. Authorized Official

Name: MR. MOSS ELLENBOGEN
Title or Position: PRESIDENT AND TREASURER
Credential:
Phone: 305-308-3878