Provider Demographics
NPI:1104814979
Name:ST. ANNES NURSING CENTER ST. ANNES RESIDENCE INC.
Entity type:Organization
Organization Name:ST. ANNES NURSING CENTER ST. ANNES RESIDENCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CABEZAS
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:305-252-4000
Mailing Address - Street 1:11855 QUAIL ROOST DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-3956
Mailing Address - Country:US
Mailing Address - Phone:954-739-6233
Mailing Address - Fax:954-733-1532
Practice Address - Street 1:11855 QUAIL ROOST DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-3956
Practice Address - Country:US
Practice Address - Phone:954-739-6233
Practice Address - Fax:954-733-1532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1515096310400000X, 313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020947300Medicaid
FL105560Medicare ID - Type UnspecifiedPROVIDER NUMBER