Healthcare Provider Details

I. General information

NPI: 1629004262
Provider Name (Legal Business Name): SPRINGTREE REHABILITATION & HEALTH CARE CTR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4251 SPRINGTREE DR
SUNRISE FL
33351
US

IV. Provider business mailing address

4251 SPRINGTREE DR
SUNRISE FL
33351
US

V. Phone/Fax

Practice location:
  • Phone: 954-572-4251
  • Fax: 954-572-6410
Mailing address:
  • Phone: 954-572-4251
  • Fax: 954-572-6410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF15120961
License Number StateFL

VIII. Authorized Official

Name: MRS. VERONICA LOGAN
Title or Position: ADMINISTRATOR FOR SPRINGTREE REHAB
Credential: BSW
Phone: 954-572-4251