Healthcare Provider Details

I. General information

NPI: 1629685961
Provider Name (Legal Business Name): HARDEE FL OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ORANGE PL
WAUCHULA FL
33873-3417
US

IV. Provider business mailing address

1449 37TH ST STE 605
BROOKLYN NY
11218-4382
US

V. Phone/Fax

Practice location:
  • Phone: 646-649-1131
  • Fax:
Mailing address:
  • Phone: 212-444-1991
  • 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: DAVID HERSKOWITZ
Title or Position: MANAGER
Credential:
Phone: 212-444-1991