Healthcare Provider Details

I. General information

NPI: 1437698396
Provider Name (Legal Business Name): RSC PEMBROKE PLAZA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SW 52ND AVE
PEMBROKE PARK FL
33023-5420
US

IV. Provider business mailing address

2870 STIRLING RD SUITE 209
HOLLYWOOD FL
33020-1109
US

V. Phone/Fax

Practice location:
  • Phone: 954-961-8111
  • Fax: 954-613-2301
Mailing address:
  • Phone: 954-613-2300
  • Fax: 954-613-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: GEREMY JORDAN
Title or Position: MANAGER
Credential:
Phone: 954-613-2300