Healthcare Provider Details

I. General information

NPI: 1851450514
Provider Name (Legal Business Name): FLORIDA INSTITUTE FOR LONG TERM CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 EAST SAMPLE ROAD
POMPANO BEACH FL
33064
US

IV. Provider business mailing address

401 EAST SAMPLE ROAD
POMPANO BEACH FL
33064
US

V. Phone/Fax

Practice location:
  • Phone: 954-941-4100
  • Fax: 954-941-3484
Mailing address:
  • Phone: 954-941-4100
  • Fax: 954-941-3484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF10960962
License Number StateFL

VIII. Authorized Official

Name: MRS. MELANIE ACEVEDO
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 954-941-4100