Provider Demographics
NPI:1962549535
Name:PLAZA NURSING & REHABILITATION CENTER
Entity type:Organization
Organization Name:PLAZA NURSING & REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRETER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:305-945-7631
Mailing Address - Street 1:14601 NE 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-2614
Mailing Address - Country:US
Mailing Address - Phone:305-945-7631
Mailing Address - Fax:305-956-5603
Practice Address - Street 1:14601 NE 16TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-2614
Practice Address - Country:US
Practice Address - Phone:305-945-7631
Practice Address - Fax:305-956-5603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1448096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL028481500Medicaid
FL105767Medicare Oscar/Certification