Provider Demographics
NPI:1437158656
Name:FLORIDA CLUB CARE CENTER OPERATING CO, LIMITED
Entity Type:Organization
Organization Name:FLORIDA CLUB CARE CENTER OPERATING CO, LIMITED
Other - Org Name:FLORIDA CLUB CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:LENARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-663-4044
Mailing Address - Street 1:220 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3855
Mailing Address - Country:US
Mailing Address - Phone:305-653-8427
Mailing Address - Fax:856-665-5708
Practice Address - Street 1:1114 WYNNWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3256
Practice Address - Country:US
Practice Address - Phone:856-663-4044
Practice Address - Fax:856-665-5708
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENIORS MANAGEMENT NORTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-19
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1154096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105469Medicare Oscar/Certification
FL105469Medicare ID - Type Unspecified