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NPI Code Detail

MEDICARE: BROOKWOOD GARDENS CONVALESCENT CENTER OPERATIONS LLC

MEDICARE: BROOKWOOD GARDENS CONVALESCENT CENTER OPERATIONS 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
1314000000XSkilled Nursing FacilitySNF1064096FL

General Provider Information

NPI Number : 1912995200
Entity Type Code : Organization
Provider Name (Legal Business Name) : BROOKWOOD GARDENS CONVALESCENT CENTER OPERATIONS LLC
Provider Business Mailing Address
First Line : 1990 S CANAL DR
Second Line :
City : HOMESTEAD
State : FL
Zip : 33035-1046
Country : US
Telephone Number : 305-246-1200
Fax Number : 305-246-9570
Provider Business Practice Location Address
First Line : 1990 S CANAL DR
Second Line :
City : HOMESTEAD
State : FL
Zip : 33035-1046
Country : US
Telephone Number : 305-246-1200
Fax Number : 305-246-9570
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. EDWIN COELHO
Credential : NHA
Telephone Number : 305-246-1200
Provider Enumeration Date : 10/11/2005
Last Update Date : 08/22/2020

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