Provider Demographics
NPI:1780696336
Name:PALMETTO SUB ACUTE CARE CENTER INC
Entity type:Organization
Organization Name:PALMETTO SUB ACUTE CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-261-2525
Mailing Address - Street 1:7600 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4462
Mailing Address - Country:US
Mailing Address - Phone:305-261-2525
Mailing Address - Fax:305-261-5232
Practice Address - Street 1:7600 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4462
Practice Address - Country:US
Practice Address - Phone:305-261-2525
Practice Address - Fax:305-261-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF 1423096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021280600Medicaid
FL105939Medicare ID - Type Unspecified
FL021280600Medicaid