Healthcare Provider Details

I. General information

NPI: 1073331914
Provider Name (Legal Business Name): DELRAY NURSING AND REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 SW 11TH CT FL 33445
DELRAY BEACH FL
33445-6013
US

IV. Provider business mailing address

2105 SW 11TH CT FL 33445
DELRAY BEACH FL
33445-6013
US

V. Phone/Fax

Practice location:
  • Phone: 561-454-1136
  • Fax:
Mailing address:
  • Phone: 561-454-1136
  • Fax:

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: MRS. TRICIA THACKER
Title or Position: CEO
Credential:
Phone: 813-558-6600