Provider Demographics
NPI:1124133798
Name:HOLLYWOOD HEALTHCARE CORP
Entity type:Organization
Organization Name:HOLLYWOOD HEALTHCARE CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-349-9551
Mailing Address - Street 1:15851 SW 41ST ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-1541
Mailing Address - Country:US
Mailing Address - Phone:954-349-9551
Mailing Address - Fax:954-349-9552
Practice Address - Street 1:15851 SW 41ST ST
Practice Address - Street 2:SUITE 700
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33331-1541
Practice Address - Country:US
Practice Address - Phone:954-349-9551
Practice Address - Fax:954-349-9552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH16241332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2291970Medicaid
MN524128600Medicaid
MT5605529Medicaid
NMK2125Medicaid
OK100247010BMedicaid
OK100247010AMedicaid
KY54003371Medicaid
IN200357480AMedicaid
NV3388230Medicaid
ID806289500Medicaid
AZ636251Medicaid
MD699759700Medicaid
MI4480718Medicaid
KSDME 100411330BMedicaid
GA00932654AMedicaid
NJ8771511Medicaid
MD699759700Medicaid
NE=========54Medicaid
NMK2125Medicaid
GA00932654AMedicaid