Provider Demographics
NPI:1922017425
Name:CORAL REEF OPERATING LLC
Entity Type:Organization
Organization Name:CORAL REEF OPERATING LLC
Other - Org Name:CORAL REEF NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:UHLENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-488-6789
Mailing Address - Street 1:1 UNIVERSITY PLZ
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6201
Mailing Address - Country:US
Mailing Address - Phone:201-488-6789
Mailing Address - Fax:201-488-7734
Practice Address - Street 1:9869 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1703
Practice Address - Country:US
Practice Address - Phone:305-255-3220
Practice Address - Fax:305-255-1778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1641096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0282529-00Medicaid
FL105910Medicare ID - Type Unspecified
FL105910Medicare Oscar/Certification