Provider Demographics
NPI:1417949579
Name:FLORIDA DEPARTMENT OF VETERANS AFFAIRS
Entity Type:Organization
Organization Name:FLORIDA DEPARTMENT OF VETERANS AFFAIRS
Other - Org Name:ALEXANDER 'SANDY' NININGER STATE VETERANS NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-518-3202
Mailing Address - Street 1:8401 W CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-4540
Mailing Address - Country:US
Mailing Address - Phone:954-985-4824
Mailing Address - Fax:954-985-4866
Practice Address - Street 1:8401 W CYPRESS DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-4540
Practice Address - Country:US
Practice Address - Phone:954-985-4824
Practice Address - Fax:954-985-4866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF130471019311500000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022984900Medicaid
FL022984900Medicaid