Healthcare Provider Details

I. General information

NPI: 1710186481
Provider Name (Legal Business Name): HIALEAH SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 10/04/2013
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

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

V. Phone/Fax

Practice location:
  • Phone: 305-512-4688
  • Fax: 305-825-8255
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1424096
License Number StateFL

VIII. Authorized Official

Name: MR. TZVI BOGOMILSKY
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 305-401-7901