Healthcare Provider Details

I. General information

NPI: 1033701628
Provider Name (Legal Business Name): CENTER FOR AGING AND REHABILITATION OF DAVENPORT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W ORANGE ST
DAVENPORT FL
33837-3118
US

IV. Provider business mailing address

3550 POWERLINE RD
OAKLAND PARK FL
33309-5917
US

V. Phone/Fax

Practice location:
  • Phone: 863-422-4961
  • Fax: 863-422-1707
Mailing address:
  • Phone: 954-367-4597
  • Fax: 954-367-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY ANNE WOOD
Title or Position: MANAGER
Credential:
Phone: 954-367-4597