Provider Demographics
NPI:1407823032
Name:FLORIDEAN NURSING HOME, INC.
Entity type:Organization
Organization Name:FLORIDEAN NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE-SCHILD
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:305-649-2911
Mailing Address - Street 1:47 NW 32ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4914
Mailing Address - Country:US
Mailing Address - Phone:305-649-2911
Mailing Address - Fax:
Practice Address - Street 1:47 NW 32ND PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4914
Practice Address - Country:US
Practice Address - Phone:305-649-2911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF11570951314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020042500Medicaid
FL10-6007Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER