Provider Demographics
NPI:1770226466
Name:HCR MANOR CARE SERVICES OF FLORIDA III, LLC
Entity Type:Organization
Organization Name:HCR MANOR CARE SERVICES OF FLORIDA III, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-252-5734
Mailing Address - Street 1:PO BOX 10086
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43699-0086
Mailing Address - Country:US
Mailing Address - Phone:567-585-1191
Mailing Address - Fax:
Practice Address - Street 1:5975 SUNSET DR STE 301
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5198
Practice Address - Country:US
Practice Address - Phone:305-234-1780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HCR MANOR CARE SERVICES OF FLORIDA III, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0192558-00Medicaid