Healthcare Provider Details

I. General information

NPI: 1427044635
Provider Name (Legal Business Name): SALEM NURSING & REHAB CENTER OF HOMESTEAD MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 NW 1ST AVE
HOMESTEAD FL
33030-4212
US

IV. Provider business mailing address

1330 NW 1ST AVE
HOMESTEAD FL
33030-4212
US

V. Phone/Fax

Practice location:
  • Phone: 305-248-0271
  • Fax: 305-248-7654
Mailing address:
  • Phone: 305-248-0271
  • Fax: 305-248-7654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF12410952
License Number StateFL

VIII. Authorized Official

Name: MS. MISSY SOMERS
Title or Position: BUSINESS OFFICE MGR
Credential:
Phone: 305-270-7041