Provider Demographics
NPI:1588765267
Name:HEBREW HOME OF SOUTH BEACH INC
Entity type:Organization
Organization Name:HEBREW HOME OF SOUTH BEACH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNWOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-672-6464
Mailing Address - Street 1:320 COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-6903
Mailing Address - Country:US
Mailing Address - Phone:305-672-6464
Mailing Address - Fax:305-672-3243
Practice Address - Street 1:320 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-6903
Practice Address - Country:US
Practice Address - Phone:305-672-6464
Practice Address - Fax:305-672-3243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1351096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105097Medicare Oscar/Certification