MEDICARE: DELRAY NURSING AND REHAB 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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1508678145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELRAY NURSING AND REHAB LLC

Provider Business Mailing Address
First Line	:	2105 SW 11TH CT
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-6013
Country	:	US
Telephone Number	:	561-454-1136
Fax Number	:

Provider Business Practice Location Address
First Line	:	2105 SW 11TH CT
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-6013
Country	:	US
Telephone Number	:	561-454-1136
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. TRICIA THACKER
Credential	:
Telephone Number	:	813-558-6600

Provider Enumeration Date	:	01/21/2025
Last Update Date	:	01/21/2025

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