MEDICARE: LAKE WORTH SNF 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	SNF1133096	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952377541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE WORTH SNF LLC

Provider Business Mailing Address
First Line	:	7491 W OAKLAND PARK BLVD
Second Line	:	SUITE 100
City	:	TAMARAC
State	:	FL
Zip	:	33319-4989
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1711 6TH AVE S
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-4333
Country	:	US
Telephone Number	:	561-586-0808
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RON OSTROFF
Credential	:
Telephone Number	:	954-358-1660

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	07/02/2008

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