Provider Demographics
NPI:1750650610
Name:6414 13TH ROAD SOUTH OPERATIONS LLC
Entity Type:Organization
Organization Name:6414 13TH ROAD SOUTH OPERATIONS LLC
Other - Org Name:WOOD LAKE HEALTH AND REHABILITATION CENTER
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 1:6414 13TH ROAD S
Mailing Address - Street 2:
Mailing Address - City:W. PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-1401
Mailing Address - Country:US
Mailing Address - Phone:561-478-9900
Mailing Address - Fax:561-478-5067
Practice Address - Street 1:6414 13TH ROAD S
Practice Address - Street 2:
Practice Address - City:W. PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-1401
Practice Address - Country:US
Practice Address - Phone:561-478-9900
Practice Address - Fax:561-478-5067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF13390962314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004778800Medicaid
FL004778800Medicaid