NPI |
1669768594 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
HCR MANOR CARE SERVICES OF FLORIDA III, LLC |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Other Organization Name |
PROMEDICA HOSPICE (BROWARD) |
Other name by which the organization provider is or has been known. |
Provider Other Organization Name Type Code |
3 |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider First Line Business Practice Location Address |
150 S PINE ISLAND RD STE 540 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
PLANTATION |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
FL |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
333242667 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
9544677423 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
9544677087 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
6/20/2011 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Last Update Date |
1/23/2022 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
ALLEN |
Other name by which the organization provider is or has been known. |
Authorized Official First Name |
MARTIN |
The first name of the authorized official. |
Authorized Official Middle Name |
D |
The middle name of the authorized official. |
Authorized Official Title or Position |
DIRECTOR |
The title or position of the authorized official. |
Authorized Official Telephone Number |
4192525734 |
The country code in the location address of the provider being identified. |
Healthcare Provider Taxonomy Code 1 |
251G00000X |
The telephone number associated with the location address of the provider being identified. |
Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
Healthcare Provider Taxonomy Code 2 |
251G00000X |
|
Provider License Number State Code 2 |
FL |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 2 |
Y |
|
Is Organization Subpart |
N |
|
Authorized Official Name Prefix Text |
MR. |
|
NPI Certification Date |
1/23/2022 |
|