Healthcare Provider Details

I. General information

NPI: 1124023783
Provider Name (Legal Business Name): PALM COURT NH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 06/27/2021
Certification Date: 06/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 N ANDREWS AVE
WILTON MANORS FL
33311-2509
US

IV. Provider business mailing address

2675 N ANDREWS AVE
WILTON MANORS FL
33311-2509
US

V. Phone/Fax

Practice location:
  • Phone: 954-563-5711
  • Fax: 954-563-5729
Mailing address:
  • Phone: 954-563-5711
  • Fax: 954-563-5729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF14050963
License Number StateFL

VIII. Authorized Official

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