| Entity Name: | PLANTATION NURSING & REHABILITATION CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 14 Apr 2000 (25 years ago) |
| Document Number: | L00000004380 |
| FEI/EIN Number | 651002392 |
| Address: | 4250 NW 5TH STREET, PLANTATION, FL, 33317 |
| Mail Address: | 4250 NW 5TH STREET, PLANTATION, FL, 33317 |
| ZIP code: | 33317 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487681656 | 2006-06-26 | 2015-01-27 | 4250 NW FIFTH STREET, PLANTATION, FL, 333172160, US | 4250 NW FIFTH STREET, PLANTATION, FL, 333172160, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 954-587-3296 |
| Fax | 9545870664 |
Authorized person
| Name | MR. NEIL SUTTON |
| Role | ADMINISTRATOE |
| Phone | 9545873296 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| Is Primary | No |
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF1447096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS HEALTH OPTIONS |
| Number | LO4 |
| State | FL |
| Issuer | MEDICAID |
| Number | 022601700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WEISMAN ANDREW S | Agent | 5310 NW 33RD AVENUE, FT LAUDERDALE, FL, 33309 |
| Name | Role |
|---|---|
| HBA HEALTH SYSTEMS, LLC | Manager |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000017243 | THE KIDZ KORNER | EXPIRED | 2019-02-01 | 2024-12-31 | No data | 4250 NW 5 STREET, PLANTATION, FL, 33317 |
| G12000092536 | THE KIDZ KORNER | EXPIRED | 2012-09-20 | 2017-12-31 | No data | 4250 NW 5TH STREET, PLANTATION, FL, 33317 |
| G12000092529 | PLANTATION NURSING & REHAB CENTER | EXPIRED | 2012-09-20 | 2017-12-31 | No data | 4250 NW 5TH STREET, PLANTATION, FL, 33317 |
| G11000043465 | PLANTATION NURSING & REHABILITATION CENTER | ACTIVE | 2011-05-05 | 2027-12-31 | No data | 4250 NW 5TH STREET, PLANTATION, FL, 33317 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
