Healthcare Provider Details

I. General information

NPI: 1932172202
Provider Name (Legal Business Name): FMSC JEFFERSONVILLE OPERATING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 BISCAYNE BLVD SUITE 301
MIAMI FL
33181
US

IV. Provider business mailing address

11900 BISCAYNE BLVD SUITE 301
MIAMI FL
33181
US

V. Phone/Fax

Practice location:
  • Phone: 305-892-1790
  • Fax:
Mailing address:
  • Phone: 305-892-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. NELSON ROBAINA JR.
Title or Position: VP OF REIMBURSMENTS
Credential: B.S.
Phone: 305-892-1790