Provider Demographics
NPI:1346837622
Name:SOMH FORT LAUDERDALE OPERATING, LLC
Entity Type:Organization
Organization Name:SOMH FORT LAUDERDALE OPERATING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-595-6025
Mailing Address - Street 1:3001 E OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1806
Mailing Address - Country:US
Mailing Address - Phone:754-212-3249
Mailing Address - Fax:954-566-0293
Practice Address - Street 1:3001 E OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1806
Practice Address - Country:US
Practice Address - Phone:754-212-3249
Practice Address - Fax:954-566-0293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)