Provider Demographics
NPI:1225763691
Name:ORMOND REHABILITATION AND NURSING CENTER LLC
Entity Type:Organization
Organization Name:ORMOND REHABILITATION AND NURSING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-613-1662
Mailing Address - Street 1:103 CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5982
Mailing Address - Country:US
Mailing Address - Phone:386-673-0450
Mailing Address - Fax:386-676-1302
Practice Address - Street 1:103 CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5982
Practice Address - Country:US
Practice Address - Phone:386-673-0450
Practice Address - Fax:386-676-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1397096OtherLICENSE