Provider Demographics
NPI:1588619340
Name:WEST PALM BEACH HEALTH CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:WEST PALM BEACH HEALTH CARE ASSOCIATES LLC
Other - Org Name:RENAISSANCE HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRULEWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-689-1799
Mailing Address - Street 1:5065 WALLIS RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-1947
Mailing Address - Country:US
Mailing Address - Phone:561-689-1799
Mailing Address - Fax:561-640-4603
Practice Address - Street 1:5065 WALLIS RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-1947
Practice Address - Country:US
Practice Address - Phone:561-689-1799
Practice Address - Fax:561-640-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1198096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025254900Medicaid
105558Medicare Oscar/Certification