Healthcare Provider Details

I. General information

NPI: 1043226400
Provider Name (Legal Business Name): ALDERSGATE HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 W 16TH AVE
HIALEAH FL
33012-2104
US

IV. Provider business mailing address

5300 W 16TH AVE
HIALEAH FL
33012-2104
US

V. Phone/Fax

Practice location:
  • Phone: 305-556-3500
  • Fax: 305-821-1407
Mailing address:
  • Phone: 305-556-3500
  • Fax: 305-821-1407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1235096
License Number StateFL

VIII. Authorized Official

Name: MR. GARY FEATHERS
Title or Position: DIRECTOR
Credential:
Phone: 305-238-9954