Provider Demographics
NPI:1437805033
Name:PALATKA NURSING AND REHAB OP LLC
Entity Type:Organization
Organization Name:PALATKA NURSING AND REHAB OP LLC
Other - Org Name:RADIANT NURSING AND REHAB AT PALATKA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YISROEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-328-1472
Mailing Address - Street 1:501 S PALM AVE
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-4147
Mailing Address - Country:US
Mailing Address - Phone:386-328-1472
Mailing Address - Fax:
Practice Address - Street 1:501 S PALM AVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-4147
Practice Address - Country:US
Practice Address - Phone:386-328-1472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility