Healthcare Provider Details

I. General information

NPI: 1912264136
Provider Name (Legal Business Name): MULBERRY GROVE NH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 06/27/2021
Certification Date: 06/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16529 SE 86TH BELLE MEADE CIRCLE
THE VILLAGES FL
32162
US

IV. Provider business mailing address

16529 SE 86TH BELLE MEADE CIRCLE
THE VILLAGES FL
32162
US

V. Phone/Fax

Practice location:
  • Phone: 352-385-8200
  • Fax: 352-385-8888
Mailing address:
  • Phone: 352-385-8200
  • Fax: 352-385-8888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF130471050
License Number StateFL

VIII. Authorized Official

Name: MOSHE SCHEINER
Title or Position: CEO
Credential:
Phone: 813-557-6200