MEDICARE: TERRACES FACILITY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	SNF1133096	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114304094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRACES FACILITY INC

Provider Business Mailing Address
First Line	:	4302 HOLLYWOOD BLVD
Second Line	:	#369
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6635
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1711 6TH AVE S
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-4333
Country	:	US
Telephone Number	:	561-586-0808
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED REPRESENTATIVE
Name	:	MR. MICHAEL BLEICH
Credential	:
Telephone Number	:	845-641-8314

Provider Enumeration Date	:	04/30/2015
Last Update Date	:	05/14/2015

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