MEDICARE: WATERFORD REHABILITATION AND NURSING CENTER

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	SNF1586096	FL

General Provider Information

NPI Number	:	1780673640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATERFORD REHABILITATION AND NURSING CENTER

Provider Business Mailing Address
First Line	:	8333 W OKEECHOBEE RD
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2109
Country	:	US
Telephone Number	:	305-556-9900
Fax Number	:	305-821-8027

Provider Business Practice Location Address
First Line	:	8333 W OKEECHOBEE RD
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2109
Country	:	US
Telephone Number	:	305-556-9900
Fax Number	:	305-821-8027

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ROBERTO DIZON VITAL
Credential	:	N.H.A
Telephone Number	:	305-556-9900

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	08/22/2020

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