Dixie Highway SNF LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

DIXIE HIGHWAY SNF LLC

Doing business as

South Campus Rehabilitation and Nursing Center

Practice address

715 E Dixie Ave
Leesburg, FL 34748-5926

Phone

(352) 728-3020

Fax

(352) 728-6071

NPI assigned

Oct 26, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Tzvi Bogomilsky

Title

Authorized Member

Phone

(305) 403-1400

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• South Campus Rehabilitation and Nursing Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354752000000",
    "number": "1073866166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 NE MIAMI GARDENS DR # 368",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "331795035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 E DIXIE AVE",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485926",
            "telephone_number": "352-728-3020",
            "fax_number": "352-728-6071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIXIE HIGHWAY SNF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-26",
        "last_updated": "2012-12-06",
        "status": "A",
        "authorized_official_last_name": "BOGOMILSKY",
        "authorized_official_first_name": "TZVI",
        "authorized_official_title_or_position": "AUTHORIZED MEMBER",
        "authorized_official_telephone_number": "305-403-1400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025295600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Campus Rehabilitation and Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rosendo Diego Diaz, M.D.
• Tanya I Diaz, MD
• Christopher Dinnan, APRN, FNP-C
• Divine Expectations
• Kristina Jo Dix, PTA
• James Randall Dockham, COTA
• Barry Michael Doherty, PTA
• Scott D. Doll, APRN
• Steven Dolliver, MA
• Charles L Domson II, M.D.

• Skilled Nursing Facility in Leesburg, FL
• Providers in Leesburg, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.