Provider Demographics
NPI:1124023783
Name:PALM COURT NH, LLC
Entity Type:Organization
Organization Name:PALM COURT NH, LLC
Other - Org Name:WILTON MANORS HEALTH & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-557-6200
Mailing Address - Street 1:2675 N ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33311-2509
Mailing Address - Country:US
Mailing Address - Phone:954-563-5711
Mailing Address - Fax:954-563-5729
Practice Address - Street 1:2675 N ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33311-2509
Practice Address - Country:US
Practice Address - Phone:954-563-5711
Practice Address - Fax:954-563-5729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF14050963314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0227579-00Medicaid
FL5551000001Medicare NSC
FL105119Medicare Oscar/Certification