Provider Demographics
NPI:1720713175
Name:MIDDLEBURG REHABILITATION AND NURSING CENTER LLC
Entity Type:Organization
Organization Name:MIDDLEBURG REHABILITATION AND NURSING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-613-1662
Mailing Address - Street 1:1280 HENLEY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-7886
Mailing Address - Country:US
Mailing Address - Phone:904-600-3798
Mailing Address - Fax:904-600-3799
Practice Address - Street 1:1280 HENLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-7886
Practice Address - Country:US
Practice Address - Phone:904-600-3798
Practice Address - Fax:904-600-3799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL130471082OtherLICENSE