Provider Demographics
NPI:1043265416
Name:BRANDON HEALTH CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:BRANDON HEALTH CARE ASSOCIATES LLC
Other - Org Name:BRANDON HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KUELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-655-0404
Mailing Address - Street 1:1465 OAKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4854
Mailing Address - Country:US
Mailing Address - Phone:813-655-0404
Mailing Address - Fax:813-654-9589
Practice Address - Street 1:1465 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4854
Practice Address - Country:US
Practice Address - Phone:813-655-0404
Practice Address - Fax:813-654-9589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF130470969314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025207700Medicaid
105951Medicare Oscar/Certification