Provider Demographics
NPI:1487681656
Name:PLANTATION NURSING & REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:PLANTATION NURSING & REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOE
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-587-3296
Mailing Address - Street 1:4250 NW FIFTH STREET
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2160
Mailing Address - Country:US
Mailing Address - Phone:954-587-3296
Mailing Address - Fax:954-587-0664
Practice Address - Street 1:4250 NW FIFTH STREET
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2160
Practice Address - Country:US
Practice Address - Phone:954-587-3296
Practice Address - Fax:954-587-0664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
FLSNF1447096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLO4OtherBCBS HEALTH OPTIONS
FL022601700Medicaid
FL105175Medicare Oscar/Certification