Healthcare Provider Details

I. General information

NPI: 1780696336
Provider Name (Legal Business Name): PALMETTO SUB ACUTE CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 SW 8TH ST
MIAMI FL
33144-4462
US

IV. Provider business mailing address

7600 SW 8TH ST
MIAMI FL
33144-4462
US

V. Phone/Fax

Practice location:
  • Phone: 305-261-2525
  • Fax: 305-261-5232
Mailing address:
  • Phone: 305-261-2525
  • Fax: 305-261-5232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF 1423096
License Number StateFL

VIII. Authorized Official

Name: MR. KHALID MIRZA
Title or Position: PRESIDENT
Credential:
Phone: 305-261-2525