Organization
PHOENIX HEALTHCARE PROPERTIES OF MANDARIN, LLC
Active
Other names
Southlake Nursing and Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DION R. SENA (MANAGING MEMBER)
(305) 759-4046
Entity
Organization
Contact information
Practice address
10680 SAINT AUGUSTINE ROAD, JACKSONVILLE, FL 32257-1000
(904) 268-4953
Mailing address
199 NE 89TH STREET, EL PORTAL, FL 33138-3010
(305) 759-4046
(305) 759-4056
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF13060961
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031237100
—
FL
01
—
L69
BLUE CROSS INSURANCE
FL
Enumeration date
07/08/2006
Last updated
12/01/2009
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