Provider Demographics
NPI:1902390727
Name:2599 NW 55TH AVENUE OPERATIONS, LLC
Entity Type:Organization
Organization Name:2599 NW 55TH AVENUE OPERATIONS, LLC
Other - Org Name:NSPIRE HEALTHCARE LAUDERHILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:PASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-769-6280
Mailing Address - Street 1:2599 NW 55TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-2443
Mailing Address - Country:US
Mailing Address - Phone:954-485-8873
Mailing Address - Fax:954-484-1951
Practice Address - Street 1:2599 NW 55TH AVE
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313
Practice Address - Country:US
Practice Address - Phone:407-571-1550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-15
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100296900Medicaid