Organization
DIXIE HIGHWAY SNF LLC
Active
Other names
South Campus Rehabilitation and Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TZVI BOGOMILSKY (AUTHORIZED MEMBER)
(305) 403-1400
Entity
Organization
Contact information
Practice address
715 E DIXIE AVE, LEESBURG, FL 34748-5926
(352) 728-3020
(352) 728-6071
Mailing address
1835 NE MIAMI GARDENS DR # 368, NORTH MIAMI BEACH, FL 33179-5035
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025295600
—
FL
Enumeration date
10/26/2012
Last updated
12/06/2012
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