Healthcare Provider Details

I. General information

NPI: 1407823032
Provider Name (Legal Business Name): FLORIDEAN NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 NW 32ND PL
MIAMI FL
33125-4914
US

IV. Provider business mailing address

47 NW 32ND PL
MIAMI FL
33125-4914
US

V. Phone/Fax

Practice location:
  • Phone: 305-649-2911
  • Fax:
Mailing address:
  • Phone: 305-649-2911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF11570951
License Number StateFL

VIII. Authorized Official

Name: MRS. KELLEY RICE-SCHILD
Title or Position: OWNER/ADMINISTRATOR
Credential: NHA
Phone: 305-649-2911