Healthcare Provider Details

I. General information

NPI: 1760499404
Provider Name (Legal Business Name): HOBE SOUND GERIATRIC VILLAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 SE FEDERAL HWY
HOBE SOUND FL
33455-2009
US

IV. Provider business mailing address

11700 E 10 MILE RD
WARREN MI
48089-3903
US

V. Phone/Fax

Practice location:
  • Phone: 772-546-5800
  • Fax: 772-546-6567
Mailing address:
  • Phone: 586-759-5966
  • Fax: 586-759-8006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number13200961
License Number StateFL

VIII. Authorized Official

Name: MR. DONALD J BORTZ
Title or Position: PRESIDENT
Credential:
Phone: 586-759-5966