Healthcare Provider Details

I. General information

NPI: 1154071561
Provider Name (Legal Business Name): THE PONCE THERAPY CARE CENTER AND REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 OLD MOULTRIE RD
ST AUGUSTINE FL
32086-5164
US

IV. Provider business mailing address

1999 OLD MOULTRIE RD
ST AUGUSTINE FL
32086-5164
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-3311
  • Fax:
Mailing address:
  • Phone:
  • 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: MOSHE SCHEINER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 845-490-6060