Healthcare Provider Details

I. General information

NPI: 1538925714
Provider Name (Legal Business Name): PLAZA HEALTHCARE AND REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4842 SW ARCHER RD
GAINESVILLE FL
32608-3813
US

IV. Provider business mailing address

4842 SW ARCHER RD
GAINESVILLE FL
32608-3813
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-8821
  • Fax:
Mailing address:
  • Phone: 352-376-8821
  • 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: MR. MOSS ELLENBOGEN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 305-308-3878