Healthcare Provider Details

I. General information

NPI: 1194303016
Provider Name (Legal Business Name): CORAL REEF SUBACUTE CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9869 SW 152ND ST
MIAMI FL
33157-1703
US

IV. Provider business mailing address

180 SYLVAN AVE STE 4
ENGLEWOOD CLIFFS NJ
07632-2519
US

V. Phone/Fax

Practice location:
  • Phone: 201-731-1700
  • Fax:
Mailing address:
  • Phone: 201-731-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MARK FRIEDMAN
Title or Position: MANAGER
Credential:
Phone: 201-731-1700