Provider Demographics
NPI:1225039605
Name:BREA PALMER RANCH LLC
Entity Type:Organization
Organization Name:BREA PALMER RANCH LLC
Other - Org Name:BROOKDALE PALMER RANCH SNF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:LESKOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-918-5000
Mailing Address - Street 1:5111 PALMER RANCH PKWY
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-4477
Mailing Address - Country:US
Mailing Address - Phone:941-926-1966
Mailing Address - Fax:941-926-7755
Practice Address - Street 1:5111 PALMER RANCH PKWY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-4477
Practice Address - Country:US
Practice Address - Phone:941-926-1966
Practice Address - Fax:941-926-7755
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKDALE SENIOR LIVING, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-09
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031924400Medicaid
FL026932800Medicaid
FLSNF130471010OtherSTATE OF FLORIDA AHCA
FL031924400Medicaid