Healthcare Provider Details

I. General information

NPI: 1982671749
Provider Name (Legal Business Name): HIALEAH SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6750 W 22ND CT
HIALEAH FL
33016-3918
US

IV. Provider business mailing address

7491 W OAKLAND PARK BLVD SUITE100
TAMARAC FL
33319-4989
US

V. Phone/Fax

Practice location:
  • Phone: 305-823-3119
  • Fax:
Mailing address:
  • Phone: 954-958-1660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1424096
License Number StateFL

VIII. Authorized Official

Name: RON OSTROFF
Title or Position: OWNER
Credential:
Phone: 954-358-1660