Healthcare Provider Details

I. General information

NPI: 1861418790
Provider Name (Legal Business Name): MELWOOD NURSING CENTER, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 E SHERIDAN RD
MELBOURNE FL
32901-3227
US

IV. Provider business mailing address

3001 KEITH ST NW
CLEVELAND TN
37312-3713
US

V. Phone/Fax

Practice location:
  • Phone: 321-727-0984
  • Fax: 321-727-3606
Mailing address:
  • Phone: 423-473-5751
  • Fax: 423-339-8342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF12390961
License Number StateFL

VIII. Authorized Official

Name: CINDY S CROSS
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 423-473-5867