MEDICARE: RSC HIDDEN OAKS FORT MYERS, LLC

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	310400000X	Assisted Living Facility	AL5531	FL

General Provider Information

NPI Number	:	1215335914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RSC HIDDEN OAKS FORT MYERS, LLC

Provider Business Mailing Address
First Line	:	4425 ADAMS AVE
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-2929
Country	:	US
Telephone Number	:	786-999-3711
Fax Number	:

Provider Business Practice Location Address
First Line	:	3625 HIDDEN TREE LN
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8388
Country	:	US
Telephone Number	:	786-999-3711
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. GEREMY JORDAN
Credential	:
Telephone Number	:	786-999-3711

Provider Enumeration Date	:	12/11/2014
Last Update Date	:	12/11/2014

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