Organization
MANOR PINES CONVALESCENT CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SALLY P BOLEN (CFO)
(954) 566-8353
Entity
Organization
Contact information
Practice address
1701 NE 26TH ST, WILTON MANORS, FL 33305-1412
(954) 566-8353
(954) 566-1416
Mailing address
1601 NE 26TH ST, WILTON MANORS, FL 33305-1410
(954) 566-8353
(954) 563-3939
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF16270961
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0254177-00
—
FL
Enumeration date
07/05/2006
Last updated
03/15/2012
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