Provider Demographics
NPI:1912995200
Name:BROOKWOOD GARDENS CONVALESCENT CENTER OPERATIONS LLC
Entity Type:Organization
Organization Name:BROOKWOOD GARDENS CONVALESCENT CENTER OPERATIONS LLC
Other - Org Name:BROOKWOOD GARDENS REHABILITATION & NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COELHO
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:305-246-1200
Mailing Address - Street 1:1990 S CANAL DR
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33035-1046
Mailing Address - Country:US
Mailing Address - Phone:305-246-1200
Mailing Address - Fax:305-246-9570
Practice Address - Street 1:1990 S CANAL DR
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33035-1046
Practice Address - Country:US
Practice Address - Phone:305-246-1200
Practice Address - Fax:305-246-9570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1064096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
105550Medicare ID - Type Unspecified