Provider Demographics
NPI:1386835650
Name:GAINESVILLE HEALTH AD REHABILITATION CENTER
Entity type:Organization
Organization Name:GAINESVILLE HEALTH AD REHABILITATION CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:DALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-377-1981
Mailing Address - Street 1:4000 SW 20TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607
Mailing Address - Country:US
Mailing Address - Phone:352-377-1981
Mailing Address - Fax:352-377-0277
Practice Address - Street 1:4000 SW 20TH AVENUE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607
Practice Address - Country:US
Practice Address - Phone:352-377-1981
Practice Address - Fax:352-377-1981
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LP O HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-05
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1170096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105664Medicare Oscar/Certification
6100470001Medicare NSC