Healthcare Provider Details

I. General information

NPI: 1922017425
Provider Name (Legal Business Name): CORAL REEF OPERATING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9869 SW 152ND ST
MIAMI FL
33157-1703
US

IV. Provider business mailing address

1 UNIVERSITY PLZ SUITE 206
HACKENSACK NJ
07601-6201
US

V. Phone/Fax

Practice location:
  • Phone: 305-255-3220
  • Fax: 305-255-1778
Mailing address:
  • Phone: 201-488-6789
  • Fax: 201-488-7734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1641096
License Number StateFL

VIII. Authorized Official

Name: GAYLE UHLENBURG
Title or Position: MEMBER
Credential:
Phone: 201-488-6789