MEDICARE: PLAZA NURSING & REHABILITATION 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	SNF1448096	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	:	1962549535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAZA NURSING & REHABILITATION CENTER

Provider Business Mailing Address
First Line	:	14601 NE 16TH AVE
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-2614
Country	:	US
Telephone Number	:	305-945-7631
Fax Number	:	305-956-5603

Provider Business Practice Location Address
First Line	:	14601 NE 16TH AVE
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-2614
Country	:	US
Telephone Number	:	305-945-7631
Fax Number	:	305-956-5603

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. BARRY PRETER
Credential	:	NHA
Telephone Number	:	305-945-7631

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	06/30/2008

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