Healthcare Provider Details

I. General information

NPI: 1669863890
Provider Name (Legal Business Name): HOLLYWOOD HILLS OPERATOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N 35TH AVE
HOLLYWOOD FL
33021-5413
US

IV. Provider business mailing address

8301 ROOSEVELT BLVD
PHILADELPHIA PA
19152-2006
US

V. Phone/Fax

Practice location:
  • Phone: 954-981-5511
  • Fax: 954-981-7229
Mailing address:
  • Phone: 215-624-7575
  • Fax: 215-624-7020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1238096
License Number StateFL

VIII. Authorized Official

Name: LISA SOFIA
Title or Position: MEMBER
Credential:
Phone: 215-624-7575