Provider Demographics
NPI:1669768594
Name:HCR MANOR CARE SERVICES OF FLORIDA III, LLC
Entity type:Organization
Organization Name:HCR MANOR CARE SERVICES OF FLORIDA III, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-252-5734
Mailing Address - Street 1:150 S PINE ISLAND RD STE 540
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2667
Mailing Address - Country:US
Mailing Address - Phone:954-467-7423
Mailing Address - Fax:954-467-7087
Practice Address - Street 1:150 S PINE ISLAND RD STE 540
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2667
Practice Address - Country:US
Practice Address - Phone:954-467-7423
Practice Address - Fax:954-467-7087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
FL251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101502Medicare Oscar/Certification