Provider Demographics
NPI:1669863890
Name:HOLLYWOOD HILLS OPERATOR, LLC
Entity Type:Organization
Organization Name:HOLLYWOOD HILLS OPERATOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOFIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-624-7575
Mailing Address - Street 1:8301 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2006
Mailing Address - Country:US
Mailing Address - Phone:215-624-7575
Mailing Address - Fax:215-624-7020
Practice Address - Street 1:1200 N 35TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5413
Practice Address - Country:US
Practice Address - Phone:954-981-5511
Practice Address - Fax:954-981-7229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1238096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility