Manor Pines Convalescent Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF16270961 Issued in FL

Legal business name

MANOR PINES CONVALESCENT CENTER, LLC

Practice address

1701 NE 26TH St
Wilton Manors, FL 33305-1412

Phone

(954) 566-8353

Fax

(954) 566-1416

NPI assigned

Jul 5, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Sally P Bolen

Title

Cfo

Phone

(954) 566-8353

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331769600000",
    "number": "1619907326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 NE 26TH ST",
            "city": "WILTON MANORS",
            "state": "FL",
            "postal_code": "333051410",
            "telephone_number": "954-566-8353",
            "fax_number": "954-563-3939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 NE 26TH ST",
            "city": "WILTON MANORS",
            "state": "FL",
            "postal_code": "333051412",
            "telephone_number": "954-566-8353",
            "fax_number": "954-566-1416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANOR PINES CONVALESCENT CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2012-03-15",
        "status": "A",
        "authorized_official_last_name": "BOLEN",
        "authorized_official_first_name": "SALLY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "954-566-8353",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF16270961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0254177-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samuel Majer
• Mario Maldonado Jr.
• David Allan Malkevich, M.D.
• Tamika Mallard I, SOCIAL WORKER, BS
• Ashley Mann, MS
• Manuel a Castro MD PA
• Marc J Romano, Psy.D., Inc.
• Landie Djenie Marc, MSW
• Maria L. Bondi LMHC Dapa
• Mark Richards Inc

• Skilled Nursing Facility in Wilton Manors, FL
• Providers in Wilton Manors, 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 Mar 15, 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.