Assessment Cost Document, October 2020
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Assessment Cost Document October 2020.xlsx Annualized Medicaid 20% Indigent Provider Facility Zip Medicaid Number PermID FRAES ID License # Census Days Type Facility Name Facility Address City Code CCRC Beds Days 001135 962 36103 1540096 FALSE SNF SURREY PLACE CARE CENTER 110 SOUTHEAST LEE AVENUE LIVE OAK 32060 FALSE 60 11,728 001136 869 95031 1544096 FALSE SNF SUTTON PLACE CARE CENTER 4405 LAKEWOOD ROAD LAKE WORTH 33461 FALSE 120 21,206 001416 441 93101 1152096 FALSE SNF FLORIDA BAPTIST RETIREMENT CENTER 1006 33RD ST. VERO BEACH 32960 FALSE 24 3,256 002400 941 80806 10560961 FALSE SNF VILLAGE PLACE HEALTH AND REHABILITATION CENTER 2370 HARBOR BLVD. PORT CHARLOTTE 33952 FALSE 104 20,449 005372 424 46406 1123096 FALSE SNF DEBARY MANOR 60 N. HIGHWAY 17-92 DEBARY 32713 FALSE 120 26,503 005374 904 41801 1331096 FALSE SNF FLAGLER PINES 300 SOUTH LEMON STREET BUNNELL 32110 FALSE 120 17,923 005379 772 75904 12970961 FALSE SNF LONGWOOD HEALTH CARE CENTER 1520 SOUTH GRANT STREET LONGWOOD 32750 FALSE 120 25,902 005380 825 74811 14280961 FALSE SNF REHABILITATION CENTER OF WINTER PARK, THE 1700 MONROE AVENUE MAITLAND 32751 FALSE 180 36,966 005381 935 23302 10680961 FALSE SNF BRYNWOOD CENTER 1656 SOUTH JEFFERSON STREET MONTICELLO 32344 FALSE 97 26,488 005383 1056 23203 13730962 FALSE SNF NURSING PAVILION AT CHIPOLA RETIREMENT CENTER 4294 3RD AVENUE MARIANNA 32446 FALSE 60 14,679 005384 1072 20307 11740962 FALSE SNF GLENCOVE NURSING PAVILION 1027 EAST HIGHWAY BUSINESS 98 PANAMA CITY 32401 FALSE 115 19,568 005385 621 20305 14270951 FALSE SNF PANAMA CITY NURSING CENTER 924 WEST 13TH STREET PANAMA CITY 32401 FALSE 120 25,364 005386 902 22002 1477096 FALSE SNF RIVERCHASE CARE CENTER 1017 STRONG ROAD QUINCY 32351 FALSE 120 36,089 005387 837 36102 1545096 FALSE SNF SUWANNEE HEALTH CARE CENTER 1620 HELVENSTON STREETS E LIVE OAK 32064 FALSE 180 47,696 005519 396 70502 10740961 FALSE SNF CARNEGIE GARDENS NURSING CENTER 1415 SOUTH HICKORY STREET MELBOURNE 32901 FALSE 138 26,765 005543 459 46409 1148096 FALSE SNF MANOR ON THE GREEN 324 WILDER BOULEVARD DAYTONA BEACH 32114 FALSE 192 43,325 005547 425 46407 1124095 FALSE SNF OAKWOOD GARDEN OF DELAND 451 SOUTH AMELIA AVENUE DELAND 32724 FALSE 122 33,000 005549 783 74903 13790951 FALSE SNF OAKS OF KISSIMMEE 320 NORTH MITCHELL AVENUE KISSIMMEE 34741 FALSE 59 13,051 005701 543 34204 1524096 FALSE SNF AVANTE AT OCALA 2021 SOUTHWEST 1ST AVENUE Ocala 34474 FALSE 133 23,973 005814 515 95006 1109096 FALSE SNF BOYNTON HEALTH CARE CENTER 7900 VENTURE CENTER WAY BOYNTON BEACH 33437 FALSE 99 14,107 005849 391 55211 1173096 FALSE SNF GLEN OAKS HEALTH CARE 1100 PINE STREET CLEARWATER 33756 FALSE 76 21,709 005850 418 55102 1118096 FALSE SNF HERITAGE PARK 37135 COLEMAN AVENUE DADE CITY 33525 FALSE 120 29,851 005851 504 33502 12710951 FALSE SNF LAKE EUSTIS CARE CENTER 411 W. WOODWARD AVENUE EUSTIS 32726 FALSE 90 18,141 006339 845 62802 1274095 FALSE SNF LAKE PLACID HEALTH CARE CENTER 125 TOMOKA BOULEVARD SOUTH LAKE PLACID 33852 FALSE 180 35,193 006340 1028 30402 1608096 FALSE SNF WINDSOR MANOR 602 EAST LAURA STREET STARKE 32091 FALSE 120 25,465 006483 894 94302 14880961 FALSE SNF SALERNO BAY MANOR 4801 S.E. COVE ROAD STUART 34997 FALSE 120 27,875 006489 884 95030 1483096 FALSE SNF ROYAL MANOR 600 BUSINESS PARKWAY ROYAL PALM BEACH 33411 FALSE 120 26,287 006767 927 82602 1333096 FALSE SNF OAKBROOK OF LABELLE 250 BROWARD AVENUE LABELLE 33935 FALSE 93 24,544 010453 1110 85821 1204096 FALSE SNF HEARTLAND HEALTH CARE & REHABILITATION CENTER 5401 SAWYER ROAD SARASOTA 34233 FALSE 140 9,318 011997 1131 95044 1628095 FALSE SNF Heartland Health and Rehab 7225 BOCA DEL MAR DRIVE Boca Raton 33433 FALSE 120 7,009 011998 645 93103 1486096 FALSE SNF Royal Palm Healthcare and Rehab Center 2180 10TH AVENUE VERO BEACH 32960 FALSE 72 9,325 015613 1293 35961023 130471042 FALSE SNF ST. JAMES HEALTH AND REHAB CENTER 239 CROOKED RIVER ROAD CARRABELLE 32322 FALSE 90 24,564 017221 374 11702 1053096 FALSE SNF BAYSIDE MANOR 4343 LANGLEY AVENUE PENSACOLA 32504 FALSE 120 29,009 017222 891 100602 10510962 FALSE SNF Margate Health Care Center 5951 COLONIAL DRIVE Margate 33063 FALSE 170 29,054 017223 435 11704 1482096 FALSE SNF ROSEWOOD MANOR 3107 NORTH H STREET PENSACOLA 32501 FALSE 155 36,666 017225 861 15701 1033096 FALSE SNF BAY BREEZE NURSING AND RETIREMENT CENTER 3387 GULF BREEZE PARKWAY GULF BREEZE 32561 FALSE 120 26,723 017230 977 14607 1501096 FALSE SNF SILVERCREST MANOR 910 BROOKMEADE DRIVE CRESTVIEW 32539 FALSE 60 13,706 017236 1065 11709 13270961 FALSE SNF SPECIALTY CENTER OF PENSACOLA 6984 PINE FOREST ROAD PENSACOLA 32526 FALSE 120 26,365 017242 965 14606 15780961 FALSE SNF Health Care Center of Destin 138 SANDESTIN LANE Destin 32550 FALSE 97 15,575 018777 377 85826 10400961 FALSE SNF BAY VILLAGE OF SARASOTA 8400 VAMO ROAD SARASOTA 34231 TRUE 95 4,612 019085 464 55222 11770962 FALSE SNF GOLFVIEW HEALTHCARE CENTER 3636 10TH AVENUE NORTH SAINT PETERSBURG 33713 FALSE 56 12,004 019282 601 55109 15060961 FALSE SNF SOUTHERN PINES HEALTHCARE CENTER 6140 CONGRESS STREET NEW PORT RICHEY 34653 FALSE 120 22,039 019284 494 41606 10800961 FALSE SNF CEDAR HILLS HEALTHCARE CENTER 2061 HYDE PARK RD JACKSONVILLE 32210 FALSE 180 40,877 019287 462 100608 11760963 FALSE SNF GOLFCREST HEALTHCARE CENTER 600 NORTH 17TH AVENUE HOLLYWOOD 33020 FALSE 67 15,780 021261 928 46420 1191096 FALSE SNF Coastal Health & Rehab 820 NORTH CLYDE MORRIS BLVD. DAYTONA BEACH 32117 FALSE 120 26,845 022138 824 46402 1164095 FALSE SNF Carlton Shores Health and Rehab 1350 SOUTH NOVA ROAD DAYTONA BEACH 32114 FALSE 118 24,413 022987 1181 35960874 1652096 FALSE SNF BLOUNTSTOWN HEALTH AND REHABILITATION CENTER 16690 S.W. CHIPOLA ROAD BLOUNTSTOWN 32424 FALSE 96 20,664 022994 488 62936 12400962 FALSE SNF HOME ASSOCIATION, INC., THE 1203 22ND AVENUE TAMPA 33605 FALSE 96 21,772 023067 877 94701 1388096 FALSE SNF OKEECHOBEE HEALTH CARE FACILITY 1646 HIGHWAY 441 NORTH OKEECHOBEE 34972 FALSE 180 50,322 024167 849 114401 1265096 FALSE SNF KEY WEST HEALTH & REHBILITATION 5860 W. JUNIOR COLLEGE ROAD KEY WEST 33040 FALSE 120 25,488 026536 362 100624 1028096 FALSE SNF WEST BROWARD CARE CENTER 7751 W. BROWARD BLVD. PLANTATION 33324 FALSE 120 29,228 032049 1295 35961021 130471044 FALSE SNF CLYDE E. LASSEN STATE VETERAN'S NURSING HOME 4650 STATE ROAD 16 ST. AUGUSTINE 32092 FALSE 120 11,822 032482 497 111321 1254096 FALSE SNF UNITY HEALTH AND REHABILITATION CENTER 1404 NW 22ND STREET MIAMI 33142 FALSE 270 71,749 032486 1245 35960932 130470994 FALSE SNF LADY LAKE SPECIALTY CARE CENTER 630 GRIFFEN AVENUE LADY LAKE 32159 FALSE 145 32,224 032551 1068 85820 15720961 FALSE SNF SUNSET LAKE HEALTH AND REHABILITATION CENTER 832 SUNSET LAKE BLVD VENICE 34292 FALSE 120 17,480 032553 405 55214 10950962 FALSE SNF LEXINGTON HEALTH AND REHABILITATION CENTER 6300 46TH AVENUE NORTH SAINT PETERSBURG 33709 FALSE 159 37,190 Agency for Health Care Administration Burea of Medicaid Program Finance 1 9/25/2020 Assessment Cost Document October 2020.xlsx Annualized Medicaid 20% Indigent Provider Facility Zip Medicaid Number PermID FRAES ID License # Census Days Type Facility Name Facility Address City Code CCRC Beds Days 033175 763 23701 1073096 FALSE SNF SEVEN HILLS HEALTH & REHAB CENTER 3333 CAPITAL MEDICAL BLVD. TALLAHASSEE 32308 FALSE 156 36,277 033717 1297 35961033 130471046 FALSE SNF BENDERSON FAMILY SKILLED NURSING & REHAB CTR 1955 NORTH HONORE AVE. SARASOTA 34235 FALSE 45 6,065 038640 1298 35961029 130471047 FALSE SNF NUVISTA LIVING AT WELLINGTON GREEN 10330 DEVONSHIRE BLVD WELLINGTON 33414 FALSE 120 2 041324 1299 35961024 130471048 FALSE SNF NUVISTA LIVING AT HILLSBOROUGH LAKES 19091 North Dale Mabry Highway Lutz 33548 FALSE 120 2,763 043832 806 32702 1137096 FALSE SNF HERON POINTE HEALTH AND REHABILITATION 1445 HOWELL AVENUE BROOKSVILLE 34601 FALSE 120 30,568 043833 832 23702 12210961 FALSE SNF HERITAGE HEALTHCARE CENTER 3101 GINGER DRIVE TALLAHASSEE 32308 FALSE 180 43,380 043835 841 85804 1223096 FALSE SNF HERITAGE HEALTH CARE CENTER 1026 ALBEE FARM ROAD VENICE 34292 FALSE 120 29,235 043838 463 81102 1224096 FALSE SNF HERITAGE HEALTHCARE & REHABILITATION CENTER 777 NINTH STREET NORTH NAPLES 34102 FALSE 97 21,115 043839 1290 74901 130471039 FALSE SNF KEYSTONE REHABILITATION AND HEALTH CENTER 1120 WEST DONEGAN AVENUE KISSIMMEE 34741 FALSE 120 27,217 043843 423 46405 1122096 FALSE SNF OAKTREE HEALTHCARE 650 REED CANAL ROAD SOUTH DAYTONA 32119 FALSE 65 17,079 043846 929 74817 14370961 FALSE SNF RIO PINAR HEALTH CARE 7950 LAKE UNDERHILL ROAD ORLANDO 32822 FALSE 180 47,069 043847 1227 35960914 130470985 FALSE SNF PALMS REHABILITATION AND HEALTHCARE CENTER, THE 5405 BABCOCK STREET NE PALM BAY 32905 FALSE 120 21,898 043848 956 83609 11040961 FALSE SNF CORAL TRACE HEALTH CARE 216 SANTA BARBARA BLVD CAPE CORAL 33991 FALSE 120 23,201 043850 860 74804 1089096 FALSE SNF PARKS HEALTHCARE AND REHABILITATION CENTER 9311 S. ORANGE BLOSSOM TRAIL ORLANDO 32837 FALSE 120 31,406 043851 1096 95040 10840961 FALSE SNF CORAL BAY HEALTHCARE AND REHABILITATION 2939 S. HAVERHILL ROAD WEST PALM BEACH 33415 FALSE 120 27,936 043853 1143 74908 16340962 FALSE SNF PLANTATION BAY REHABILITATION CENTER 4641 OLD CANOE CREEK ROAD SAINT CLOUD 34769 FALSE 120 26,035 043854 835 74815 1610096 FALSE SNF COLONIAL LAKES HEALTH CARE 15204 WEST COLONIAL DRIVE WINTER GARDEN 34787 FALSE 180 45,585 043856 1039 62924 1088096 FALSE SNF CENTRAL PARK HEALTHCARE & REHABILITATION CENTER 702 S. KINGS AVENUE BRANDON 33511 FALSE 120 26,077 043857 811 85801 1049096 FALSE SNF BENEVA LAKES HEALTHCARE AND REHABILITATION CENTER 741 S. BENEVA ROAD SARASOTA 34232 FALSE 120 32,209