Provider Demographics
NPI:1013063742
Name:PALM GLADES RURAL HEALTH ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PALM GLADES RURAL HEALTH ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:W
Authorized Official - Last Name:HURBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-992-4888
Mailing Address - Street 1:217 W AVENUE A
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-3019
Mailing Address - Country:US
Mailing Address - Phone:561-992-4888
Mailing Address - Fax:561-996-4358
Practice Address - Street 1:217 W AVENUE A
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-3019
Practice Address - Country:US
Practice Address - Phone:561-992-4888
Practice Address - Fax:561-996-4358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103972Medicare ID - Type Unspecified