Healthcare Provider Details

I. General information

NPI: 1174599674
Provider Name (Legal Business Name): WILDWOOD SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 S OLD WIRE RD
WILDWOOD FL
34785-5001
US

IV. Provider business mailing address

7491 WEST OAKLAND BLVD.
LAUDERHILL FL
33319
US

V. Phone/Fax

Practice location:
  • Phone: 352-748-7609
  • Fax:
Mailing address:
  • Phone: 954-358-1660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1588096
License Number StateFL

VIII. Authorized Official

Name: RON OSTROFF
Title or Position: OWNER
Credential:
Phone: 954-358-1660