- Enrollment id
- O20220831000049
- Enrollment state
- FL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1124777669
- Multiple npi flag
- N
- Ccn
- 686123
- Associate id
- 7113301771
- Organization name
- KENDALL LAKES HEALTHCARE AND REHAB CENTER, LLC
- Doing business as name
- KENDALL LAKES HEALTHCARE AND REHAB CENTER
- Incorporation date
- 2022-07-27
- Incorporation state
- FL
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- KENDALL LAKES HEALTHCARE AND REHAB CENTER
- Affiliation entity name
- GOLD FL TRUST II
- Affiliation entity id
- 594
- Address line 1
- 5280 SW 157TH AVE
- City
- MIAMI
- State
- FL
- Zip code
- 331855297