Healthcare Provider Details

I. General information

NPI: 1902472954
Provider Name (Legal Business Name): SOUTH PLATTE HEALTH AND REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 EDISON ST
BRUSH CO
80723-1609
US

IV. Provider business mailing address

2420 KNAPP ST
BROOKLYN NY
11235-1006
US

V. Phone/Fax

Practice location:
  • Phone: 970-842-2825
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ZISHA MARGULIES
Title or Position: CEO
Credential:
Phone: 718-942-3483