Healthcare Provider Details

I. General information

NPI: 1437805033
Provider Name (Legal Business Name): PALATKA NURSING AND REHAB OP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S PALM AVE
PALATKA FL
32177-4147
US

IV. Provider business mailing address

501 S PALM AVE
PALATKA FL
32177-4147
US

V. Phone/Fax

Practice location:
  • Phone: 386-328-1472
  • Fax:
Mailing address:
  • Phone: 386-328-1472
  • 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: MR. YISROEL ROSENBAUM
Title or Position: PRESIDENT
Credential:
Phone: 386-328-1472