Provider Demographics
NPI:1043266455
Name:PALM BAY HEALTH CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:PALM BAY HEALTH CARE ASSOCIATES LLC
Other - Org Name:PALMS REHABILITATION AND HEALTHCARE CENTER, THE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-722-0660
Mailing Address - Street 1:5405 BABCOCK ST NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-5020
Mailing Address - Country:US
Mailing Address - Phone:321-722-0660
Mailing Address - Fax:321-722-2669
Practice Address - Street 1:5405 BABCOCK ST NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5020
Practice Address - Country:US
Practice Address - Phone:321-722-0660
Practice Address - Fax:321-722-2669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF130470985314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025239500Medicaid
105985Medicare Oscar/Certification