Provider Demographics
NPI:1689943334
Name:6700 NW 10TH PLACE OPERATIONS LLC
Entity Type:Organization
Organization Name:6700 NW 10TH PLACE OPERATIONS LLC
Other - Org Name:NORTH FLORIDA REHABILITATION AND SPECIALTY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:USSERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-571-1550
Mailing Address - Street 1:6700 NW 10TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4213
Mailing Address - Country:US
Mailing Address - Phone:352-331-3111
Mailing Address - Fax:352-332-9232
Practice Address - Street 1:6700 NW 10TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4213
Practice Address - Country:US
Practice Address - Phone:352-331-3111
Practice Address - Fax:352-332-9232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF13690962314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004388000Medicaid
FL004388000Medicaid