Provider Demographics
NPI:1437698396
Name:RSC PEMBROKE PLAZA
Entity Type:Organization
Organization Name:RSC PEMBROKE PLAZA
Other - Org Name:PLAZA OF PEMBROKE PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-613-2300
Mailing Address - Street 1:2870 STIRLING RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-1109
Mailing Address - Country:US
Mailing Address - Phone:954-613-2300
Mailing Address - Fax:954-613-2301
Practice Address - Street 1:3535 SW 52ND AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33023-5420
Practice Address - Country:US
Practice Address - Phone:954-961-8111
Practice Address - Fax:954-613-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility