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General NPI Number Information
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NPI Number | 1962895086
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Entity Type | Organization
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Legal Business Name | CITRUS NURSING CENTER LLC
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Dates
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Enumeration Date | 03/13/2015
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Last Update Date | 03/13/2015
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Provider Practice Location Address
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Address Line | 701 MEDICAL CT E
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City | INVERNESS
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State | FL
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Zip | 34452-4616
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Country | US
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Telephone | 352-860-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 398 E DANIA BEACH BLVD # 306
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City | DANIA BEACH
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State | FL
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Zip | 33004-3051
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED REPRESENTATIVE
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Name | ALEX AMSELEM
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Credential |
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Telephone | 305-968-1227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | SNF1620096
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License Number State | FL
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