Healthcare Provider Details

I. General information

NPI: 1821105677
Provider Name (Legal Business Name): GAINESVILLE REHABILITATION AND NURSING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SW 16TH AVE
GAINESVILLE FL
32601-8425
US

IV. Provider business mailing address

1835 NE MIAMI GARDENS DR #368
NORTH MIAMI BEACH FL
33179-5035
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-2461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF10050951
License Number StateFL

VIII. Authorized Official

Name: TZVI BOGOMILSKY
Title or Position: AUTHORIZED MEMBER
Credential:
Phone: 305-401-7901