MEDICARE: MIRAMAR BEACH HCC 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	:	1679464325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRAMAR BEACH HCC LLC

Provider Business Mailing Address
First Line	:	548 CEDARWOOD DR
Second Line	:
City	:	CEDARHURST
State	:	NY
Zip	:	11516-1010
Country	:	US
Telephone Number	:	850-267-2887
Fax Number	:

Provider Business Practice Location Address
First Line	:	138 SANDESTIN LN
Second Line	:
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-5815
Country	:	US
Telephone Number	:	850-267-2887
Fax Number	:

Authorized Official
Title or Position	:	EVP
Name	:	CHAIM LEIBOWITZ
Credential	:
Telephone Number	:	850-267-2887

Provider Enumeration Date	:	07/11/2025
Last Update Date	:	07/11/2025

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