Provider Demographics
NPI:1427044635
Name:SALEM NURSING & REHAB CENTER OF HOMESTEAD MANOR
Entity Type:Organization
Organization Name:SALEM NURSING & REHAB CENTER OF HOMESTEAD MANOR
Other - Org Name:HOMESTEAD MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:MISSY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-270-7041
Mailing Address - Street 1:1330 NW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4212
Mailing Address - Country:US
Mailing Address - Phone:305-248-0271
Mailing Address - Fax:305-248-7654
Practice Address - Street 1:1330 NW 1ST AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4212
Practice Address - Country:US
Practice Address - Phone:305-248-0271
Practice Address - Fax:305-248-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF12410952314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021212100Medicaid
FL021212100Medicaid