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 043859 1262 35960946 130471011 FALSE SNF BRADENTON HEALTH CARE 6305 CORTEZ ROAD WEST BRADENTON 34210 FALSE 105 21,197 043860 1215 35960904 130470969 FALSE SNF BRANDON HEALTH AND REHABILITATION CENTER 1465 OAKFIELD DRIVE BRANDON 33511 FALSE 120 19,084 043861 433 95602 10040953 FALSE SNF FORT PIERCE HEALTH CARE 611 SOUTH 13TH STREET FORT PIERCE 34950-4092 FALSE 171 45,434 043862 474 62914 15500962 FALSE SNF HABANA HEALTH CARE CENTER 2916 HABANA WAY TAMPA 33614 FALSE 150 42,936 043863 426 55218 11260961 FALSE SNF HEALTH AND REHABILITATION CENTRE AT DOLPHINS VIEW, THE 1820 SHORE DRIVE, SOUTH SOUTH PASADENA 33707 FALSE 58 13,143 043864 1213 35960900 130470968 FALSE SNF GRAND OAKS HEALTH AND REHABILITATION CENTER 3001 PALM COAST PARKWAY SE PALM COAST 32137 FALSE 120 17,081 043865 719 41620 15640961 FALSE SNF HARTS HARBOR HEALTH CARE CENTER 11565 HARTS ROAD JACKSONVILLE 32218 FALSE 180 51,554 043866 394 62903 1071096 FALSE SNF FLETCHER HEALTH AND REHABILITATION CENTER 518 WEST FLETCHER AVE TAMPA 33612 FALSE 120 30,061 043867 1247 35960935 130470996 FALSE SNF WEDGEWOOD HEALTHCARE CENTER 1010 CARPENTERS WAY LAKELAND 33809 FALSE 120 23,890 043868 836 46408 1125096 FALSE SNF DELTONA HEALTH CARE 1851 ELKCAM BOULEVARD DELTONA 32725 FALSE 120 26,051 043871 1267 35960958 130471017 FALSE SNF LAKE MARY HEALTH AND REHABILITATION CENTER 710 NORTH SUN DRIVE LAKE MARY 32746 FALSE 120 19,636 043872 954 55263 11060962 FALSE SNF COUNTRYSIDE REHAB AND HEALTHCARE CENTER 3825 COUNTRYSIDE BLVD. PALM HARBOR 34684 FALSE 120 25,796 043873 475 100610 11940963 FALSE SNF HARBOR BEACH NURSING AND REHABILITATION CENTER 1615 SOUTH MIAMI ROAD FORT LAUDERDALE 33316 FALSE 59 14,439 043874 853 30903 1200096 FALSE SNF HEALTH CENTER AT BRENTWOOD 2333 NORTH BRENTWOOD CIRCLE LECANTO 34461 FALSE 120 24,297 043875 701 41001 1181096 FALSE SNF GOVERNORS CREEK HEALTH AND REHABILITATION 803 OAK STREET GREEN COVE SPRINGS 32043 FALSE 120 27,470 043876 1251 35960939 130471002 FALSE SNF LARGO REHABILITATION CENTER 9035 BRYAN DAIRY RD. LARGO 33777 FALSE 158 21,824 043877 696 85823 11420962 FALSE SNF MAGNOLIA HEALTH AND REHABILITATION CENTER 1507 SOUTH TUTTLE AVE SARASOTA 34239 FALSE 120 32,800 043878 749 26201 1436096 FALSE SNF MARSHALL HEALTH AND REHABILITATION CENTER 207 MARSHALL DRIVE PERRY 32347 FALSE 120 33,841 043880 850 30103 13690962 FALSE SNF NORTH FLORIDA REHABILITATION AND SPECIALTY CARE 6700 NW 10TH PLACE GAINESVILLE 32605 FALSE 120 24,553 044886 416 14601 1110096 FALSE SNF Crestview Rehabilitation Center 1849 FIRST AVENUE, EAST CRESTVIEW 32539 FALSE 180 42,803 044888 961 14605 11610951 FALSE SNF Fort Walton Rehabilitation Center 1 LBJ SR. DRIVE FORT WALTON BEACH 32548 FALSE 120 23,148 044889 365 20308 12870961 FALSE SNF Blountstown Rehabilitation Center dba River Valley Rehab 17884 N.E. CROZIER STREET BLOUNTSTOWN 32424 FALSE 150 37,493 046017 489 111319 12410952 FALSE SNF HOMESTEAD MANOR A PALACE COMMUNITY 1330 NW FIRST AVENUE HOMESTEAD 33030 FALSE 88 22,005 046128 1266 35960960 130471016 FALSE SNF VICTORIA NURSING & REHABILITATION CENTER, INC. 955 NW 3RD STREET MIAMI 33128 FALSE 264 57,425 046758 826 111336 1478096 FALSE SNF RIVERSIDE CARE CENTER 899 NW 4TH STREET MIAMI 33128 FALSE 120 35,716 047787 919 95034 1198096 FALSE SNF RENAISSANCE HEALTH AND REHABILITATION (FKA AZALEA COURT) 5065 WALLIS ROAD WEST PALM BEACH 33415 FALSE 120 35,111 047788 973 95037 13390962 FALSE SNF WOOD LAKE NURSING AND REHABILITATION CENTER 6414 13TH ROAD SOUTH WEST PALM BEACH 33415 FALSE 120 29,412 047795 691 100623 15840951 FALSE SNF HILLCREST NURSING AND REHABILITATION CENTER 4200 WASHINGTON STREET HOLLYWOOD 33021 FALSE 240 58,107 048441 547 74814 15940961 FALSE SNF HEALTH CENTRAL PARK 411 NORTH DILLARD STREET WINTER GARDEN 34787 FALSE 118 50,665 048611 1044 34208 13230961 FALSE SNF OCALA OAKS REHABILITATION CENTER 3930 E SILVER SPRINGS BLVD OCALA 34470-5006 FALSE 120 26,315 048807 1300 35961025 130471049 FALSE SNF NEW RIVIERA NURSING AND REHABILITATION CENTER 6901 YUMURI STREET CORAL GABLES 33156 FALSE 223 40,479 059369 784 83614 1070096 FALSE SNF CALUSA HARBOUR 2525 EAST FIRST ST FORT MYERS 33901 FALSE 60 6,399 059400 1070 55270 15250951 FALSE SNF STRATFORD COURT OF PALM HARBOR 45 KATHERINE BLVD PALM HARBOR 34684 FALSE 60 9,281 059404 1100 95608 1062096 FALSE SNF THE GARDENS OF PORT ST LUCIE 1699 E. LYNGATE DRIVE PORT SAINT LUCIE 34952 FALSE 30 2,346 059783 430 41608 1132096 FALSE SNF SUMMER BROOK HEALTH CARE CENTER 5377 MONCRIEF ROAD JACKSONVILLE 32209 FALSE 120 34,880 059852 1265 35960948 130471012 FALSE SNF SHOAL CREEK REHABILITATION CENTER 500 SOUTH HOSPITAL DRIVE CRESTVIEW 32539 FALSE 120 30,448 059855 840 80801 11440961 FALSE SNF ENGLEWOOD HEALTHCARE AND REHABILITATION CENTER 1111 DRURY LANE ENGLEWOOD 34224 FALSE 120 22,858

Agency for Health Care Administration Burea of Medicaid Program Finance 2 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 059866 548 70506 1349096 FALSE SNF ISLAND HEALTH AND REHABILITATION CENTER 125 ALMA BOULEVARD MERRITT ISLAND 32953 FALSE 120 27,015 059869 875 74813 14810962 FALSE SNF ROSEWOOD HEALTH AND REHABILITATION CENTER 3920 ROSEWOOD WAY ORLANDO 32808 FALSE 120 28,171 059873 1244 35960930 130470992 FALSE SNF EVANS HEALTH CARE 3735 EVANS AVENUE FORT MYERS 33901 FALSE 120 24,049 059874 766 20302 11870961 FALSE SNF SEA BREEZE HEALTH CARE 1937 JENKS AVENUE PANAMA CITY 32405 FALSE 120 24,450 059877 1207 35960907 130470973 FALSE SNF SPRING HILL HEALTH AND REHABILITATION CENTER 12170 CORTEZ BLVD. BROOKSVILLE 34613 FALSE 120 20,852 060972 520 20303 1292096 FALSE SNF EMERALD SHORES HEALTH AND REHABILITATION 626 NORTH TYNDALL PARKWAY CALLAWAY 32404 FALSE 77 14,000 060993 842 11703 1111096 FALSE SNF UNIVERSITY HILLS HEALTH AND REHABILITATION 10040 HILLVIEW ROAD PENSACOLA 32514 FALSE 120 33,917 061095 518 83606 1290096 FALSE SNF HERITAGE PARK REHABILITATION AND HEALTHCARE 2826 CLEVELAND AVENUE FORT MYERS 33901 FALSE 120 30,183 061101 1119 14609 16210961 FALSE SNF DESTIN HEALTHCARE AND REHABILITATION CENTER 195 MATTIE M. KELLY BLVD. DESTIN 32541 FALSE 119 29,815 061102 905 41604 1047096 FALSE SNF BEAUCLERC MANOR 9355 SAN JOSE BOULEVARD JACKSONVILLE 32257 FALSE 120 25,512 061107 627 100618 1441096 FALSE SNF SEAVIEW NURSING AND REHABILITATION CENTER 2401 NE 2ND STREET POMPANO BEACH 33062 FALSE 83 23,847 061109 896 70510 1580096 FALSE SNF VISTA MANOR 1550 JESS PARRISH COURT TITUSVILLE 32796 FALSE 120 25,190 061140 659 55246 15100962 FALSE SNF LAKESIDE OAKS CARE CENTER 1061 VIRGINIA STREET DUNEDIN 34698 FALSE 93 23,530 072320 1301 35961034 130471050 FALSE SNF THE CLUB HEALTH AND REHABILITATION CENTER AT THE VILLAGES 16529 SE 86TH BELLE MEADE CIRCLE THE VILLAGES 32162 FALSE 68 1 073324 664 64107 15320961 FALSE SNF BRADEN RIVER REHABILITATION CENTER, LLC 2010 MANATEE AVENUE BRADENTON 34208 FALSE 208 42,950 080062 635 65312 1277095 FALSE SNF GROVES CENTER 512 SOUTH 11TH STREET LAKE WALES 33853 FALSE 120 31,041 080068 509 65310 1279095 FALSE SNF LAKELAND HILLS CENTER 610 EAST BELLA VISTA DR. LAKELAND 33805 FALSE 120 29,646 080079 687 55252 15530961 FALSE SNF TARPON BAYOU CENTER 515 CHESAPEAKE DRIVE TARPON SPRINGS 34689 FALSE 120 33,105 080374 1089 55115 10140961 FALSE SNF CONSULATE HEALTH CARE OF BAYONET POINT 8132 HUDSON AVENUE HUDSON 34667 FALSE 120 25,230 080377 889 62917 1577096 FALSE SNF CONSULATE HEALTH CARE OF BRANDON 701 VICTORIA STREET BRANDON 33510 FALSE 120 23,342 080384 1174 41632 1647096 FALSE SNF CONSULATE HEALTH CARE OF JACKSONVILLE 4101 SOUTHPOINT DRIVE EAST JACKSONVILLE 32216 FALSE 116 26,178 080387 1257 35960940 130471004 FALSE SNF CONSULATE HEALTH CARE OF KISSIMMEE 2511 JOHN YOUNG PARKWAY NORTH KISSIMMEE 34741 FALSE 120 27,472 080391 880 65306 1245095 FALSE SNF CONSULATE HEALTH CARE OF LAKELAND 5245 NORTH SOCRUM LOOP ROAD LAKELAND 33809 FALSE 120 28,438 080393 1021 65317 10150962 FALSE SNF CONSULATE HEALTH CARE OF LAKE PARKER 2020 W. LAKE PARKER DRIVE LAKELAND 33805 FALSE 120 28,950 080394 1122 70516 16220961 FALSE SNF CONSULATE HEALTH CARE OF MELBOURNE 3033 SARNO ROAD MELBOURNE 32934 FALSE 167 35,684 080397 854 55105 1429096 FALSE SNF CONSULATE HEALTH CARE OF NEW PORT RICHEY 8417 COUNTY ROAD 54 NEW PORT RICHEY 34653 FALSE 120 29,826 080400 893 83607 1444096 FALSE SNF CONSULATE HEALTH CARE OF NORTH FORT MYERS 991 PONDELLA ROAD FORT MYERS 33903-3505 FALSE 120 28,713 080402 1013 41004 1016095 FALSE SNF CONSULATE HEALTH CARE OF ORANGE PARK 1215 KINGSLEY AVENUE ORANGE PARK 32073 FALSE 120 28,716 080405 1192 35960882 130470965 FALSE SNF CONSULATE HEALTH CARE OF PENSACOLA 235 W. AIRPORT BLVD. PENSACOLA 32505 FALSE 120 29,370 080406 900 55242 1018096 FALSE SNF CONSULATE HEALTH CARE OF SAFETY HARBOR 1410 DR MARTING LUTHER KING JR ST N SAFETY HARBOR 34695 FALSE 120 28,983 080409 1149 55278 1639096 FALSE SNF CONSULATE HEALTH CARE OF ST PETERSBURG 9393 PARK BOULEVARD SEMINOLE 33777 FALSE 120 27,876 080413 1223 35960915 130470982 FALSE SNF CONSULATE HEALTH CARE OF SARASOTA 4783 FRUITVILLE ROAD SARASOTA 34232 FALSE 81 17,497 080416 1226 35960922 130470983 FALSE SNF CONSULATE HEALTH CARE OF PORT CHARLOTTE 18480 COCHRAN BOULEVARD PORT CHARLOTTE 33948 FALSE 120 30,304 080428 1069 23706 1019096 FALSE SNF CONSULATE HEALTH CARE OF TALLAHASSEE 1650 PHILLIPS ROAD TALLAHASSEE 32308 FALSE 120 26,744 080430 868 93102 1247096 FALSE SNF CONSULATE HEALTH CARE OF VERO BEACH 1310 37TH STREET VERO BEACH 32960 FALSE 159 38,908 080431 1107 75908 1017096 FALSE SNF CONSULATE HEALTH CARE OF WEST ALTAMONTE 1099 W. TOWN PARKWAY ALTAMONTE SPRINGS 32714 FALSE 116 26,679 080432 885 95032 15950961 FALSE SNF CONSULATE HEALTH CARE OF WEST PALM BEACH 1626 DAVIS ROAD WEST PALM BEACH 33406 FALSE 120 27,284 080434 1236 35960929 130470990 FALSE SNF CONSULATE HEALTH CARE OF WINTER HAVEN 2701 LAKE ALFRED ROAD WINTER HAVEN 33881 FALSE 120 28,400 080436 1157 111359 16440961 FALSE SNF FRANCO NURSING & REHABILITATION CENTER 800 NW 95TH STREET MIAMI 33150 FALSE 120 31,031 082204 1304 35961040 130471053 FALSE SNF UNIVERSITY PLAZA REHAB AND NURSING CENTER, INC 724 NW 19TH STREET MIAMI 33136 FALSE 148 30,981 085643 1287 35961011 130471036 FALSE SNF SARASOTA BAY REHABILITATION CENTER LLC 2600 COURTLAND STREET SARASOTA 34237 FALSE 120 28,207 086990 458 45502 1521096 FALSE SNF Bartram Crossing 6209 BROOKS BARTRAM DRIVE, BUILDING 100 JACKSONVILLE 32258 FALSE 100 8,884 089220 643 111305 1042096 FALSE SNF WATERCREST CARE CENTER 16650 WEST DIXIE HWY NORTH MIAMI BEACH 33160 FALSE 150 30,194 092678 1250 35960933 130471001 FALSE SNF OSPREY POINT NURSING CENTER 1104 NORTH MAIN STREET BUSHNELL 33513 FALSE 60 11,229 092681 1108 31204 12700961 FALSE SNF BAYA POINTE NURSING AND REHABILITATION CENTER 587 S.E. ERMINE AVE LAKE CITY 32025 FALSE 90 18,055 094353 1302 35961031 130471051 FALSE SNF HAWTHORNE HEALTH AND REHAB OF SARASOTA 5381 DESOTO ROAD SARASOTA 34235 FALSE 120 15,642 096150 802 11713 1029096 FALSE SNF WILLOWBROOKE COURT AT AZALEA TRACE 10100 HILLVIEW ROAD PENSACOLA 32514 TRUE 82 1,067 098577 976 111346 1410096 FALSE SNF PALM GARDEN OF AVENTURA 21251 EAST DIXIE HIGHWAY NORTH MIAMI BEACH 33180 FALSE 120 24,320 098580 951 55262 1407096 FALSE SNF PALM GARDEN OF CLEARWATER 3480 MCMULLEN BOOTH ROAD CLEARWATER 33761 FALSE 165 27,703 098581 946 30106 1408096 FALSE SNF PALM GARDEN OF GAINESVILLE 227SW 62ND BOULEVARD GAINESVILLE 32607 FALSE 150 25,143 098582 1016 41625 1406096 FALSE SNF PALM GARDEN OF JACKSONVILLE 5275 SPRING PARK ROAD JACKSONVILLE 32216 FALSE 120 27,272 098583 945 55261 1409096 FALSE SNF PALM GARDEN OF LARGO 10500 STARKEY ROAD LARGO 33777 FALSE 140 26,562 098584 938 34205 1411096 FALSE SNF PALM GARDEN OF OCALA 2700 SW 34TH STREET OCALA 34474 FALSE 180 40,027 098586 953 74818 1412096 FALSE SNF PALM GARDEN OF ORLANDO 654 EAST ECONLOCKHATCHEE TRAIL ORLANDO 32825-6402 FALSE 132 26,097 098587 1051 55269 1418095 FALSE SNF PALM GARDEN OF PINELLAS 200 16TH AVENUE SE LARGO 33771 FALSE 120 26,234 098588 966 95606 1419096 FALSE SNF PALM GARDEN OF PORT SAINT LUCIE 1751 HILLMOOR DRIVE PORT SAINT LUCIE 34952 FALSE 120 24,575

Agency for Health Care Administration Burea of Medicaid Program Finance 3 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 098589 1052 62925 1421096 FALSE SNF PALM GARDEN OF SUN CITY 3850 UPPER CREEK DRIVE SUN CITY CENTER 33573 FALSE 120 22,862 098590 958 62922 1420095 FALSE SNF PALM GARDEN OF TAMPA 3612 138TH AVENUE TAMPA 33613 FALSE 120 21,860 098591 957 93105 1415096 FALSE SNF PALM GARDEN OF VERO BEACH 1755 37TH STREET VERO BEACH 32960 FALSE 189 35,914 098592 972 95036 1416096 FALSE SNF PALM GARDEN OF WEST PALM BEACH 300 EXECUTIVE CENTER DRIVE WEST PALM BEACH 33401 FALSE 176 37,120 098593 943 65314 1414096 FALSE SNF PALM GARDEN OF WINTER HAVEN 1120 CYPRESS GARDEN BOULEVARD WINTER HAVEN 33884 FALSE 120 24,747 098972 1216 35960906 130470978 FALSE SNF COMMUNITY HEALTH AND REHABILITATION CENTER 3611 TRANSMITTER ROAD PANAMA CITY 32404 FALSE 120 19,909 100487 1105 74907 14850951 FALSE SNF PALMS AT PARK PLACE, THE 221 PARK PLACE BLVD. KISSIMMEE 34741 FALSE 120 25,945 100509 906 11701 1030095 FALSE SNF BAPTIST MANOR 10095 HILLVIEW ROAD PENSACOLA 32514 FALSE 150 31,100 101391 721 55287 1374096 FALSE SNF THE OAKS OF CLEARWATER 420 BAY AVENUE CLEARWATER 33756 FALSE 60 11,322 101959 501 55230 10760961 FALSE SNF CARRINGTON PLACE OF ST PETE 10501 ROOSEVELT BLVD NORTH SAINT PETERSBURG 33716 FALSE 120 25,208 101961 1291 35961016 130471040 FALSE SNF TRINITY REGIONAL REHAB CENTER 2144 WELBILT BOULEVARD TRINITY 34655 FALSE 120 21,821 102419 914 74904 1505096 FALSE SNF The Terrace of St. Cloud 3855 OLD CANOE CREEK ROAD SAINT CLOUD 34769 FALSE 120 33,029 102586 381 65321 1607096 FALSE SNF CROSSROADS, THE 206 WEST ORANGE STREET DAVENPORT 33837 FALSE 60 13,518 102592 981 95053 1219096 FALSE SNF CROSSINGS, THE 4445 PINE FOREST DR. LAKE WORTH 33463 FALSE 60 14,185 102787 419 100606 1119096 FALSE SNF CROSS POINTE CARE CENTER 440 PHIPPEN CARE ROAD DANIA BEACH 33004 FALSE 88 24,814 102791 745 55221 11300961 FALSE SNF CROSS TERRACE REHABILITATION CENTER 1351 SAN CHRISTOPHER DRIVE DUNEDIN 34698 FALSE 104 22,296 103165 1296 35961019 130471045 FALSE SNF ASTORIA HEALTH & REHABILITATION CENTER 701 OVERLOOK DRIVE WINTER HAVEN 33844 FALSE 132 17,946 103177 769 81401 11270961 FALSE SNF DESOTO HEALTH & REHAB, LLC 475 NURSING HOME DRIVE ARCADIA 34266 FALSE 118 12,420 103425 408 62904 1099096 FALSE SNF COMMUNITY CONVALESCENT CENTER 2202 WEST OAK AVENUE PLANT CITY 33567 FALSE 120 28,451 103852 1032 74820 13870961 FALSE SNF OCOEE HEALTH CARE CENTER 1556 MAGUIRE ROAD OCOEE 34761 FALSE 120 24,375 103858 980 33508 12990961 FALSE SNF NORTH CAMPUS REHABILITATION AND NURSING CENTER 700 N PALMETTO STREET LEESBURG 34748 FALSE 90 14,282 104875 436 11707 1434096 FALSE SNF Rehabilitation Center at Park Place 1717 WEST AVERY STREET PENSACOLA 32501 FALSE 118 29,878 108507 816 41613 13060961 FALSE SNF THE TERRACE OF JACKSONVILLE 10680 OLD ST. AUGUSTINE ROAD JACKSONVILLE 32257 FALSE 180 41,837 110482 1140 70517 16320961 FALSE SNF Viera Health & Rehabilitation Center 8050 SPYGLASS RD VIERA 32940 FALSE 114 16,675 111543 638 41618 1517096 FALSE SNF ST CATHERINE LABOURE MANOR, INC. 1750 STOCKTON STREET JACKSONVILLE 32204 FALSE 240 37,721 122229 917 80805 1504096 FALSE SNF HARBOUR HEALTH CENTER 23013 WESTCHESTER BOULEVARD PORT CHARLOTTE 33980 TRUE 120 14,865 122232 1113 62939 1618096 FALSE SNF PLAZA WEST 912 AMERICAN EAGLE BLVD SUN CITY CENTER 33573 TRUE 113 7,683 122236 805 55243 14960961 FALSE SNF SEMINOLE NURSING PAVILION 10800 TEMPLE TERRACE SEMINOLE 33772 TRUE 120 14,382 122239 979 55286 1167096 FALSE SNF FREEDOM SQUARE NURSING CENTER 10801 JOHNSON BLVD. SEMINOLE 33772 TRUE 116 11,131 122242 1059 41628 11170961 FALSE SNF CYPRESS VILLAGE 4600 MIDDLETON PARK, CIRCLE EAST JACKSONVILLE 32224 TRUE 120 6,957 122243 1030 33511 1275096 FALSE SNF LAKE HARRIS HEALTH CENTER 701 LAKE PORT BOULEVARD LEESBURG 34748 TRUE 120 10,915 122248 1053 55293 1462096 FALSE SNF SYLVAN HEALTH CENTER 2770 REGENCY OAKS BLVD. CLEARWATER 33759 TRUE 60 5,113 122250 992 64112 1168096 FALSE SNF NURSING CENTER AT FREEDOM VILLAGE, THE 6410 21ST AVENUE WEST BRADENTON 34209 TRUE 120 12,521 122340 1268 35960963 130471018 FALSE SNF WOODLAND TERRACE OF CITRUS COUNTY 124 W. NORVELL BRYANT HWY HERNANDO 34442 FALSE 120 24,537 122341 1279 35960991 130471028 FALSE SNF WOODLAND GROVE HEALTH AND REHABILITATION CENTER 4325 SOUTHPOINT BOULEVARD JACKSONVILLE 32216 FALSE 120 29,296 122342 493 46411 1244096 FALSE SNF THE GARDENS HEALTH & REHABILITATION CENTER 1704 HUNTINGTON VILLAGE CIRCLE DAYTONA BEACH 32114 FALSE 108 20,160 122343 1286 35961006 130471035 FALSE SNF ISLE HEALTH & REHABILITATION CENTER 1125 FLEMING PLANTATION ROAD ORANGE PARK 32003 FALSE 108 19,834 122344 660 30401 16030961 FALSE SNF Riverwood Health & Rehabilitation Center 808 S. COLLEY ROAD STARKE 32091 FALSE 120 27,402 122346 1271 35960968 130471021 FALSE SNF TERRACE HEALTH & REHABILITATION CENTER 7207 SW 24TH AVENUE GAINESVILLE 32607 FALSE 138 17,159 122347 1177 46431 16490961 FALSE SNF VILLA HEALTH & REHABILITATION CENTTER 120 CHIPOLA AVENUE DELAND 32730 FALSE 120 28,573 128848 373 20301 10340961 FALSE SNF BAY CENTER 1336 ST. ANDREW BLVD PANAMA CITY 32405 FALSE 160 22,317 129312 532 41006 1325096 FALSE SNF PAVILION FOR HEALTH CARE, THE ONE PAVILION PLACE PENNEY FARMS 32079 TRUE 50 961 130817 955 41002 1237096 FALSE SNF OAK VIEW REHABILITATION CENTER 833 KINGSLEY AVENUE ORANGE PARK 32073 FALSE 120 23,462 132449 452 111302 1163096 FALSE SNF FOUNTAIN MANOR HEALTH & REHABILITATION CENTER 390 NE 135TH STREET NORTH MIAMI 33161 FALSE 146 39,334 133196 472 14602 11410961 FALSE SNF EMERALD COAST CENTER 114 THIRD STREET SOUTH FORT WALTON BEACH 32548 FALSE 120 30,742 133348 410 55216 11010961 FALSE SNF EGRET COVE CENTER 550 62ND STREET SOUTH SAINT PETERSBURG 33707-1533 FALSE 120 32,302 134463 399 100616 13630951 FALSE SNF FT LAUDERDALE HEALTH AND REHABILITATION CENTER 2000 E. COMMERCIAL BLVD. FORT LAUDERDALE 33308 FALSE 169 35,020 135581 1091 14608 13080951 FALSE SNF MANOR AT BLUE WATER BAY, THE 1500 NORTH WHITE PT. ROAD NICEVILLE 32578 FALSE 120 19,429 136522 357 41601 1007096 FALSE SNF CROSS CARE CENTER 5888 BLANDING BOULEVARD JACKSONVILLE 32244 FALSE 120 23,275 140643 401 55213 1091096 FALSE SNF CLEARWATER CENTER 1270 TURNER STREET CLEARWATER 33756 FALSE 120 32,321 140648 372 65301 1032096 FALSE SNF BARTOW CENTER 2055 EAST GEORGIA STREET BARTOW 33830 FALSE 120 32,878 141466 642 41616 12880962 FALSE SNF LANIER TERRACE 12740 LANIER ROAD JACKSONVILLE 32226 FALSE 120 32,762 141512 623 55239 14320962 FALSE SNF PASADENA MANOR INC 1430 PASADENA AVENUE SOUTH SOUTH PASADENA 33707 FALSE 126 14,649 143762 473 55225 11890961 FALSE SNF BOCA CIEGA CENTER 1414 59TH STREET SOUTH GULFPORT 33707 FALSE 120 30,262 146222 449 111311 11570951 FALSE SNF FLORIDIAN HEALTHCARE 47 NW 32ND PLACE MIAMI 33125 FALSE 90 13,186 147578 1123 30907 1620096 FALSE SNF CITRUS HEALTH AND REHABILITATION CENTER 701 MEDICAL COURT EAST INVERNESS 34452 FALSE 111 20,851

Agency for Health Care Administration Burea of Medicaid Program Finance 4 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 147672 388 64101 1330096 FALSE SNF BAY VUE NURSING & REHABILITATION CENTER 105 15TH STREET EAST BRADENTON 34208 FALSE 110 26,983 147948 815 36001 1588096 FALSE SNF ARBOR VILLAGE NURSING CENTER 490 SOUTH OLD WIRE ROAD Wildwood 34785 FALSE 180 33,808 147958 1139 62932 1633096 FALSE SNF EXCEL CARE CENTER 2811 CAMPUS HILL DRIVE TAMPA 33612 FALSE 120 24,646 148040 385 94301 13200961 FALSE SNF THE TERRACE AT HOBE SOUND 9555 SE FEDERAL HIGHWAY HOBE SOUND 33455 FALSE 120 31,192 151506 874 55219 11290961 FALSE SNF ADVANCED CARE CENTER 401 FAIRWOOD AVENUE CLEARWATER 33759 FALSE 120 28,287 151590 478 95011 14720952 FALSE SNF NORTH LAKE CARECENTER 750 BAYBERRY DRIVE LAKE PARK 33403 FALSE 85 25,272 151667 655 55244 1499095 FALSE SNF SHORE ACRES CARE CENTER 4500 INDIANAPOLIS STREET, NE SAINT PETERSBURG 33703 FALSE 109 26,094 151697 736 11706 1556096 FALSE SNF SOUTHERN OAKS CARE CENTER 600 WEST GREGORY STREET PENSACOLA 32501 FALSE 210 53,809 151771 774 33505 12910961 FALSE SNF SOUTH CAMPUS CARE CENTER 715 EAST DIXIE AVENUE LEESBURG 34748 FALSE 120 25,692 153181 1306 35961035 130471056 FALSE SNF GLADES WEST REHABILITATION AND NURSING CENTER 15955 BASS CREEK RD. PEMBROKE PINES 33027 FALSE 120 15,440 155062 629 111335 1442096 FALSE SNF PINES NURSING HOME 301 NE 141ST STREET NORTH MIAMI 33161 FALSE 45 12,607 156586 969 32704 1213096 FALSE SNF NORTHBROOK HEALTH AND REHABILITATION CENTER 575 LAMAR AVE BROOKSVILLE 34601 FALSE 120 26,864 157223 491 55228 12420961 FALSE SNF ST. PETERSBURG NURSING & REHABILITATION 521 69TH AVERNUE NORTH SAINT PETERSBURG 33702 FALSE 96 27,164 157224 781 82601 1092096 FALSE SNF CLEWISTON NURSING & REHABILITATION 301 SOUTH GLORIA STREET CLEWISTON 33440 FALSE 155 40,629 157225 448 65320 14530961 FALSE SNF LAKELAND NURSING & REHABILITATION 1919 LAKELAND HILLS BLVD LAKELAND 33805-2999 FALSE 185 40,239 157860 1130 30908 1626096 FALSE SNF LIFE CARE CENTER OF CITRUS COUNTY 3325 JERWAYNE LANE LECANTO 34461 FALSE 120 20,942 158851 1303 35961036 130471052 FALSE SNF THE VILLAGES REHABILITATION AND NURSING CENTER 900 HWY 466 LADY LAKE 32159 FALSE 120 1,267 159109 651 85812 1443095 FALSE SNF PINES OF SARASOTA 1501 NORTH ORANGE AVENUE SARASOTA 34236 FALSE 204 45,851 161804 697 55259 1250095 FALSE SNF BAYSIDE CARE CENTER 811 JACKSON STREET NORTH SAINT PETERSBURG 33705 FALSE 92 24,619 161828 827 74808 13920961 FALSE SNF COURTYARDS OF ORLANDO CARE CENTER 1900 MERCY DRIVE ORLANDO 32808 FALSE 120 32,981 161896 634 55107 1473096 FALSE SNF MADISON POINTE CARE CENTER 6020 INDIANA AVENUE NEW PORT RICHEY 34653 FALSE 119 25,766 161928 1224 35960917 130470981 FALSE SNF GULF SHORE CARE CENTER 6767 86TH AVENUE NORTH PINELLAS PARK 33782 FALSE 120 22,763 161944 950 111344 1424096 FALSE SNF PALMETTO CARE CENTER 6750 WEST 22ND COURT HIALEAH 33016 FALSE 90 15,552 161951 748 100601 1098096 FALSE SNF PALMS CARE CENTER 3370 NW 47TH TERRACE LAUDERDALE LAKES 33319 FALSE 120 30,394 162068 484 30101 10050951 FALSE SNF PARKLANDS CARE CENTER 1000 S.W. 16TH AVENUE GAINESVILLE 32601 FALSE 120 31,138 162074 431 95008 1133096 FALSE SNF TERRACES OF LAKE WORTH CARE CENTER 1711 6TH AVENUE SOUTH LAKE WORTH 33460 FALSE 99 27,930 162077 608 33801 1381096 FALSE SNF WILLISTON CARE CENTER 300 N.W. 1ST AVE. WILLISTON 32696 FALSE 120 30,633 162078 817 62915 13320962 FALSE SNF WOODBRIDGE CARE CENTER 8720 JACKSON SPRINGS ROAD TAMPA 33615 FALSE 120 30,565 162218 921 55112 1362096 FALSE SNF SOLARIS HEALTHCARE BAYONET POINT 7210 BEACON WOODS DRIVE HUDSON 34667 FALSE 180 36,243 162219 1118 80808 16190961 FALSE SNF SOLARIS HEALTHCARE CHARLOTTE HARBOR 4000 KINGS HIGHWAY PORT CHARLOTTE 33980 FALSE 180 38,620 162220 1218 35960920 130470979 FALSE SNF SOLARIS HEALTHCARE COCONUT CREEK 4125 W. SAMPLE ROAD COCONUT CREEK 33073 FALSE 120 21,183 162221 1166 46430 1645096 FALSE SNF SOLARIS HEALTHCARE DAYTONA 550 NATIONAL HEALTHCARE DRIVE DAYTONA BEACH 32114 FALSE 73 11,421 162222 1049 81105 14710961 FALSE SNF SOLARIS HEALTHCARE IMPERIAL 900 IMPERIAL GOLF COURSE NAPLES 34110 FALSE 113 16,942 162224 1073 31202 1417096 FALSE SNF SOLARIS HEALTHCARE LAKE CITY 560 S.W. MCFARLANE AVE. LAKE CITY 32025 FALSE 120 21,941 162225 1027 70514 1365096 FALSE SNF SOLARIS HEALTHCARE MERRITT ISLAND 500 CROCKETT BOULEVARD MERRITT ISLAND 32953 FALSE 180 33,536 162226 1090 81106 10210962 FALSE SNF SOLARIS SENIOR LIVING NORTH NAPLES 10949 PARNU STREET NAPLES 34109 FALSE 60 8,934 162228 1010 94304 1361096 FALSE SNF SOLARIS HEALTHCARE PARKWAY 800 SE CENTRAL PKWY STUART 34994 FALSE 177 41,995 162230 937 11708 14130961 FALSE SNF SOLARIS HEALTHCARE PENSACOLA 8475 UNIVERSITY PKWY PENSACOLA 32514 FALSE 180 38,846 162231 901 62911 1445096 FALSE SNF Solaris Healthcare Plant City 701 NORTH WILDER ROAD PLANT CITY 33566 FALSE 180 44,081 162232 1202 35960888 130470967 FALSE SNF SOLARIS HEALTHCARE WINDERMERE 4875 CASON COVE DRIVE ORLANDO 32811 FALSE 120 23,135 163903 822 83604 11160961 FALSE SNF FORT MYERS REHABILITATION AND NURSING CENTER 7173 CYPRESS DRIVE SOUTHWEST FORT MYERS 33907-2994 FALSE 120 29,847 166176 920 95014 12620962 FALSE SNF REHABILITATION CENTER AT JUPITER GARDENS, LLC 17781 THELMA AVE JUPITER 33458 FALSE 120 23,684 168944 680 55254 15650961 FALSE SNF EAGLE LAKE REHAB & CARE CENTER 1100 66TH STREET NORTH SAINT PETERSBURG 33710 FALSE 59 14,453 169599 440 41609 1149095 FALSE SNF FANNIE E TAYLOR HOME FOR THE AGED INC 3937 SPRING PARK ROAD JACKSONVILLE 32207 FALSE 111 6,422 170521 1263 35960957 130471013 FALSE SNF LIFE CARE CENTER OF SARASOTA 8104 NORTH TUTTLE AVENUE SARASOTA 34243 FALSE 120 16,129 173314 1248 35960937 130470998 FALSE SNF CROSS CITY NURSING AND REHABILITATION CENTER 583 N.E. HIGHWAY 351 CROSS CITY 32628 FALSE 60 11,866 173397 793 14603 1602096 FALSE SNF WESTWOOD NURSING & REHABILITATION CENTER 1001 MAR WALT DRIVE FORT WALTON BEACH 32548 FALSE 60 7,359 173398 1210 35960908 130470971 FALSE SNF LAFAYETTE HEALTH CARE CENTER 512 WEST MAIN SREET MAYO 32066 FALSE 60 14,378 173399 1146 24003 16360961 FALSE SNF LAKE PARK OF MADISON NURSING AND REHABILITATION CENTER 259 S. W. CAPTAIN BROWN RD. MADISON 32340 FALSE 120 30,331 182821 610 85805 12510961 FALSE SNF CROSSBREEZE CARE CENTER 1755 18TH STREET SARASOTA 34234 FALSE 101 28,828 182824 1067 111353 1352096 FALSE SNF CROSS GARDENS CARE CENTER 190 NE 191 STREET MIAMI 33179 FALSE 120 32,166 189252 923 55283 1094096 FALSE SNF KR AT COLLEGE HARBOR 4600 54TH AVENUE SOUTH SAINT PETERSBURG 33711 FALSE 52 9,205 191262 1050 74906 1398096 FALSE SNF SOLARIS HEALTHCARE OSCEOLA 4201 W. NEW NOLTE RD. SAINT CLOUD 34772 FALSE 120 30,724 191618 795 33512 12860961 FALSE SNF REHABILITATION AND HEALTH CARE CENTER 110 LODGE TERRACE DRIVE ALTOONA 32702 TRUE 40 886 192835 797 95604 1452096 FALSE SNF PORT SAINT LUCIE NURSING & RESTORATIVE CARE CENTER 7300 OLEANDER AVENUE PORT SAINT LUCIE 34952-8299 FALSE 180 30,685 200107 530 55232 1055096 FALSE SNF Bon Secours Maria Manor Nursing 10300 4th Street N. St. Petersburg 33716-0000 FALSE 274 61,453

Agency for Health Care Administration Burea of Medicaid Program Finance 5 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 200409 813 23709 1599096 FALSE SNF WESTMINSTER OAKS 4449 MEANDERING WAY TALLAHASSEE 32308 TRUE 120 12,511 200506 552 111327 1353096 FALSE SNF MIAMI JEWISH HOME & HOSPITAL FOR THE AGED, INC. 5200 N.E. 2ND AVENUE MIAMI 33137 FALSE 438 92,851 200714 1020 44502 15430961 FALSE SNF LIFE CARE CENTER OF HILLIARD US 1 & 3RD STREET HILLIARD 32046 FALSE 120 29,810 200859 636 41615 1476096 FALSE SNF RIVER GARDEN HEBREW HOME FOR THE AGED 11401 OLD ST. AUGUSTINE RD. JACKSONVILLE 32258 FALSE 180 31,473 200913 490 41611 10270961 FALSE SNF AVANTE VILLA AT JACKSONVILLE BEACH INC. 1504 SEABREEZE AVENUE JACKSONVILLE BEACH 32250 FALSE 165 32,347 201006 1006 100630 1342096 TRUE SNF MEMORIAL MANOR 777 SOUTH DOUGLAS ROAD PEMBROKE PINES 33025 FALSE 120 16,030 201120 996 83616 1188096 FALSE SNF GULF COAST VILLAGE CARE CENTER 1333 SANTA BARBARA BLVD. CAPE CORAL 33991 TRUE 105 7,295 201588 428 74807 1324096 FALSE SNF MARY LEE DEPUGH NURSING HOME ASSOCIATION, INC. 559 WEST MORSE BOULEVARD WINTER PARK 32789 FALSE 40 7,342 201651 625 74806 1186096 FALSE SNF GUARDIAN CARE NURSING & REHABILITATION CENTER 2500 WEST CHURCH STREET ORLANDO 32805 FALSE 120 31,332 202011 1008 55264 1596096 FALSE SNF WESTCHESTER GARDENS REHAB & CARE CENTER 3301 MCMULLEN BOOTH ROAD CLEARWATER 33761 FALSE 120 18,146 202028 895 64103 1340096 FALSE SNF MANATEE SPRINGS REHABILITATION AND NURSING CENTER 5627 9TH STREET EAST BRADENTON 34203 FALSE 120 35,625 202035 404 46403 1093096 FALSE SNF SANDALWOOD REHABILITATION AND NURSING CENTER 1001 SOUTH BEACH STREET DAYTONA BEACH 32114 FALSE 99 23,462 202533 640 65313 14790951 FALSE SNF ROHR HOME, THE 2120 MARSHALL EDWARDS DRIVE BARTOW 33830 FALSE 60 13,106 202606 646 45505 1489096 FALSE SNF SAMANTHA R WILSON SENIOR CITIZENS HOME 161 MAINE STREET SAINT AUGUSTINE 32084 FALSE 120 16,822 202711 666 85814 1535096 FALSE SNF SUNNYSIDE NURSING HOME 5201 BAHIA VISTA ST SARASOTA 34232 FALSE 60 8,866 202789 358 46429 10080961 FALSE SNF CENTER FOR HEALTH CARE OF THE ALLIANCE COMMUNITY 130 WEST ARMSTRONG AVENUE DELAND 32720 TRUE 130 19,131 202816 1309 35961061 130471059 FALSE SNF TAMPA LAKES HEALTH AND REHABILITATION CENTER 750 HAYES ROAD LUTZ 33549 FALSE 179 24,228 202941 553 23703 1354096 FALSE SNF MIRACLE HILL NURSING & CONVALESCENT CENTER, INC. 1329 ABRAHAM ST. TALLAHASSEE 32304 FALSE 120 33,019 203122 540 33504 1026096 FALSE SNF AVANTE AT LEESBURG, INC. 2000 EDGEWOOD AVENUE LEESBURG 34748 FALSE 116 23,828 203165 689 111340 1354096 FALSE SNF VILLA MARIA NURSING CENTER 1050 NE 125TH STREET NORTH MIAMI 33161 FALSE 212 52,837 203203 865 95010 1026096 FALSE SNF GLADES HEALTH CARE CENTER 230 S. BARFIELD HIGHWAY PAHOKEE 33476 FALSE 120 23,390 203220 538 30904 1576096 FALSE SNF AVANTE AT INVERNESS, INC. 304 SOUTH CITRUS AVENUE INVERNESS 34452 FALSE 104 22,915 203238 539 95017 1172096 FALSE SNF AVANTE AT LAKE WORTH, INC. 2501 NORTH A STREET LAKE WORTH 33460-6013 FALSE 138 22,946 203327 1042 111351 1024096 FALSE SNF PALACE AT KENDALL NURSING AND REHABILITATION CENTER 11215 S.W. 84TH STREET MIAMI 33173 FALSE 180 35,376 203335 1043 34207 10250961 FALSE SNF TIMBERRIDGE NURSING & REHABILITATION CENTER 9848 SW 110TH STREET OCALA 34481 FALSE 180 27,182 203475 531 23202 1401096 FALSE SNF MARIANNA HEALTH AND REHABILITATION CENTER 4295 5TH AVENUE MARIANNA 32446 FALSE 180 39,600 203599 1003 65322 1560096 FALSE SNF MANOR AT CARPENTERS, THE 1001 CARPENTER'S WAY LAKELAND 33809 TRUE 72 5,400 203670 525 111333 1322096 TRUE SNF JACKSON MEMORIAL PERDUE MEDICAL CENTER 19590 OLD CUTLER ROAD CUTLER BAY 33190 FALSE 163 33,804 203769 502 100640 1075096 FALSE SNF JOHN KNOX VILLAGE HEALTH CENTER-POMPANO BEACH 651 S.W. 6TH STREET POMPANO BEACH 33060 TRUE 194 3,710 203815 368 64114 1435096 FALSE SNF WESTMINSTER COMMUNITIES OF BRADENTON, WESTMINSTER TOWERS 1533 4TH AVENUE WEST BRADENTON 34205 TRUE 120 21,298 203980 1060 20306 1258096 FALSE SNF LISENBY ON LAKE CAROLINE 1400 WEST ELEVENTH STREET PANAMA CITY 32401 FALSE 22 6,882 204072 1046 55294 1598096 FALSE SNF MEASE CONTINUING CARE 910 NEW YORK AVENUE DUNEDIN 34698 TRUE 100 16,690 204161 492 111320 1296096 TRUE SNF JACKSON MEMORIAL LONG TERM CARE CENTER 2500 NW 22ND AVENUE MIAMI 33142 FALSE 180 38,278 204170 864 95028 13350961 FALSE SNF REGENTS PARK NURSING & REHABILITATION CENTER 6363 VERDE TRAIL BOCA RATON 33433 FALSE 180 28,077 204305 1253 35960942 1243096 FALSE SNF LIFE CARE CENTER OF PORT SAINT LUCIE 3720 SOUTH JENNINGS ROAD PORT SAINT LUCIE 34952 FALSE 123 11,065 204391 422 46413 1466096 FALSE SNF GOOD SAMARITAN SOCIETY-DAYTONA 327 ORANGE AVENUE DAYTONA BEACH 32114 FALSE 100 22,779 204625 1074 32102 130471005 FALSE SNF TRI COUNTY NURSING HOME 7280 S.W. SR 26 TRENTON 32693 FALSE 81 17,624 205303 355 74902 1389095 FALSE SNF GOOD SAMARITAN SOCIETY-KISSIMMEE VILLAGE 1550 ALDERSGATE DRIVE KISSIMMEE 34746 FALSE 170 39,631 205460 760 95001 1563096 FALSE SNF AMERICAN-FINNISH NURSING HOME 1800 SOUTH DRIVE LAKE WORTH 33461 FALSE 45 10,152 205745 737 95051 1267096 FALSE SNF HEALTH CENTER AT ABBEY DELRAY 2000 LAWSON BLVD. DELRAY BEACH 33445 TRUE 100 12,877 205796 765 74829 1011096 FALSE SNF COMMONS AT ORLANDO LUTHERAN TOWERS 300 EAST CHURCH STREET ORLANDO 32801 TRUE 168 25,623 205800 776 100620 1201096 FALSE SNF SAINT JOHNS NURSING CENTER 3075 NW 35TH AVENUE LAUDERDALE LAKES 33311 FALSE 181 46,433 205923 773 95020 1394096 FALSE SNF LOURDES-NOREEN MCKEEN RESIDENCE FOR GERIATRIC CARE, INC. 315 SOUTH FLAGLER DRIVE WEST PALM BEACH 33401 FALSE 132 27,593 206300 672 32401 1520096 FALSE SNF SUWANNEE VALLEY NURSING CENTER 427 N W 15TH AVE. JASPER 32052 FALSE 60 17,585 206431 695 55235 1298095 FALSE SNF MORTON PLANT REHABILITATION CENTER 400 CORBETT STREET BELLEAIR 33756-3392 FALSE 126 9,124 206521 746 95047 1546096 FALSE SNF WILLOWBROOKE COURT AT ST ANDREWS 6152 NORTH VERDE TRAIL BOCA RATON 33433 TRUE 89 8,894 206610 800 95048 1358095 FALSE SNF WATERFORD HEALTH CARE CENTER 601 UNIVERSE BLVD. JUNO BEACH 33408 TRUE 60 3,043 206865 812 95052 1514096 FALSE SNF HEALTH CENTER AT ABBEY DELRAY SOUTH 1717 HOMEWOOD BLVD. DELRAY BEACH 33445 TRUE 90 13,675 207381 831 95013 1587096 FALSE SNF JOSEPH L MORSE GERIATRIC CENTER INC 4847 FRED GLADSTONE DRIVE WEST PALM BEACH 33417 FALSE 310 55,920 207446 834 41619 1199096 FALSE SNF TAYLOR CARE CENTER 6635 CHESTER AVE. JACKSONVILLE 32217 FALSE 120 25,705 207497 839 100621 1261096 FALSE SNF SUNRISE HEALTH & REHABILITATION CENTER 4800 NOB HILL ROAD SUNRISE 33351 FALSE 325 38,523 207683 510 95018 1554096 FALSE SNF LAKESIDE HEALTH CENTER 2501 AUSTRALIAN AVENUE WEST PALM BEACH 33407 FALSE 107 29,048 208433 686 62916 12830961 FALSE SNF THE BRISTOL AT TAMPA REHABILITATION AND NURSING CENTER LLC 1818 EAST FLETCHER AVENUE TAMPA 33612 FALSE 266 67,311 208442 892 55233 1450096 FALSE SNF MENORAH MANOR 255 - 59 STREET NORTH SAINT PETERSBURG 33710 FALSE 180 40,374 208485 403 95015 10610962 FALSE SNF JUPITER MEDICAL CENTER PAVILION INC 1230 SOUTH OLD DIXIE HIGHWAY JUPITER 33458-7297 FALSE 90 4 208507 899 111306 1344096 FALSE SNF CLARIDGE HOUSE NURSING & REHABILITATION CENTER 13900 NE 3RD COURT NORTH MIAMI 33161 FALSE 240 65,845

Agency for Health Care Administration Burea of Medicaid Program Finance 6 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 208540 693 74830 1263096 FALSE SNF WESTMINSTER TOWERS 70 WEST LUCERNE CIRCLE ORLANDO 32801 TRUE 120 19,549 209325 857 70503 1090096 FALSE SNF COURTENAY SPRINGS VILLAGE 1100 S. COURTENAY PARKWAY MERRITT ISLAND 32952 FALSE 96 13,287 209422 389 64111 16010961 FALSE SNF WESTMINSTER COMMUNITIES OF BRADENTON, WESTMINSTER MANOR 1700 21ST AVENUE WEST BRADENTON 34205 TRUE 59 8,242 209473 940 111343 11070961 FALSE SNF ST ANNES NURSING CENTER, ST ANNES RESIDENCE INC 11855 QUAIL ROOST DRIVE MIAMI 33177 FALSE 213 48,370 209511 915 46419 1597096 FALSE SNF BISHOPS GLEN RETIREMENT CENTER 900 LPGA BLVD HOLLY HILL 32117-3100 FALSE 60 6,916 209848 698 74831 1515096 FALSE SNF WINTER PARK TOWERS 1111 SOUTH LAKEMOUNT AVENUE ,M.S. #101 WINTER PARK 32792 TRUE 80 14,140 209856 728 62938 1052096 FALSE SNF SUN TERRACE HEALTH CARE CENTER 105 TRINITY LAKES DRIVE SUN CITY CENTER 33573-5100 FALSE 130 14,758 210137 479 75903 1612096 FALSE SNF LIFE CARE CENTER OF ALTAMONTE SPRINGS 989 ORIENTA AVENUE ALTAMONTE SPRINGS 32701 FALSE 228 57,791 210188 970 100641 1527096 FALSE SNF COVENANT VILLAGE CARE CENTER 9201 WEST BROWARD BLVD. PLANTATION 33324 TRUE 60 5,826 210463 862 85825 11080961 FALSE SNF VILLAGE ON THE ISLE 950 SOUTH TAMIAMI TRAIL VENICE 34285 TRUE 64 4,757 210587 1083 83611 1260095 FALSE SNF HEALTHPARK CARE CENTER, INC. 16131 ROSE RUSH COURT FORT MYERS 33908 FALSE 112 13,685 210676 908 95024 1509096 FALSE SNF AVANTE AT BOCA RATON, INC. 1130 NORTHWEST 15TH STREET BOCA RATON 33486 FALSE 144 21,981 210684 1099 33510 1202096 FALSE SNF EDGEWATER AT WATERMAN VILLAGE 300 BROOKFIELD AVE. MOUNT DORA 32757-9562 FALSE 120 14,245 210889 1214 46425 1023095 FALSE SNF EMORY L BENNETT MEMORIAL VETERANS NURSING HOME 1920 MASON AVENUE DAYTONA BEACH 32117 FALSE 120 15,562 210951 1022 55266 1138096 FALSE SNF SABAL PALMS HEALTH CARE CENTER 499 ALTERNATE KEENE ROAD LARGO 33771 FALSE 244 42,246 211052 370 40201 1487096 FALSE SNF W FRANK WELLS NURSING HOME 159 NORTH THRID STREET MACCLENNY 32063 FALSE 68 15,779 211281 352 70501 16170961 FALSE SNF HUNTINGTON PLACE REHABILITATION AND NURSING CENTER 1775 HUNTINGTON LANE ROCKLEDGE 32955 FALSE 100 23,962 211435 762 62501 1581096 FALSE SNF HARDEE MANOR HEALTHCARE CENTER 401 ORANGE PLACE WAUCHULA 33873 FALSE 79 17,907 212032 616 95026 10030961 TRUE SNF EDWARD J HEALEY REHABILITATION AND NURSING CENTER 1200 45TH STREET WEST PALM BEACH 33407 FALSE 120 31,157 212083 692 45508 1196096 FALSE SNF WESTMINSTER WOODS ON JULINGTON CREEK 25 WILLIAM BARTRAM SCENIC HIGHWAY JACKSONVILLE 32259 TRUE 60 5,207 212164 360 62901 14030961 FALSE SNF YBOR CITY HEALTHCARE & REHABILITATION CENTER 1709 TALIAFERRO AVE. TAMPA 33602 FALSE 80 21,709 212709 663 55290 15900961 FALSE SNF WESTMINSTER SUNCOAST 6909 9TH STREET SOUTH SAINT PETERSBURG 33705 TRUE 120 19,503 212792 1191 35960881 130470995 FALSE SNF GOOD SAMARITAN SOCIETY-FLORIDA LUTHERAN 450 NORTH MCDONALD AVENUE DELAND 32724 FALSE 60 11,183 212971 1193 35960886 130470963 FALSE SNF FLORIDA PRESBYTERIAN HOMES INC 16 LAKE HUNTER DRIVE LAKELAND 33803 TRUE 68 2,700 213098 756 100622 1423096 FALSE SNF TAMARAC REHABILITATION AND HEALTH CENTER 7901 NW 88TH AVENUE TAMARAC 33321 FALSE 120 19,280 213161 1204 35960899 15490961 FALSE SNF LIFE CARE CENTER AT WELLS CROSSING 355 CROSSING BOULEVARD ORANGE PARK 32073 FALSE 120 17,220 213322 1190 35960898 1585096 FALSE SNF HARBORCHASE OF VENICE 950 PINEBROOK ROAD VENICE 34292 FALSE 45 3,788 213403 1209 35960902 130470972 FALSE SNF LIFE CARE CENTER OF ORLANDO 3211 ROUSE ROAD ORLANDO 32817 FALSE 132 23,687 213462 887 24001 130470962 FALSE SNF MADISON NURSING CENTER 2481 WEST US 90 MADISON 32340-9540 FALSE 60 17,269 213837 1212 35960910 130470974 FALSE SNF CLASSIC RESIDENCE BY HYATT AT LAKESIDE VILLAGE 2792 DONNELLY DRIVE LANTANA 33462 TRUE 60 762 213862 833 30105 1302096 FALSE SNF GAINESVILLE HEALTH CARE CENTER 4842 SW ARCHER ROAD GAINESVILLE 32607 FALSE 180 40,111 213934 1000 76 1568096 FALSE SNU TALLAHASSEE MEMORIAL HOSPITAL EXTENDED CARE 1609 MEDICAL DRIVE TALLAHASSEE 32308 FALSE 113 876 214035 605 111329 1497096 FALSE SNF MIAMI SHORES NURSING AND REHABILITATION CENTER 9380 N.E 7TH AVENUE MIAMI 33150 FALSE 99 26,238 214914 1252 35960936 1372096 FALSE SNF BALDOMERO LOPEZ MEMORIAL VETERANS NURSING HOME 6919 PARKWAY BLVD. LAND O LAKES 34639 FALSE 120 14,861 215017 1310 35961054 15430961 FALSE SNF BUFFALO CROSSING HEALTH AND REHABILITATION CENTER 3875 WEDGEWOOD LANE THE VILLAGES 32162 FALSE 120 5,902 216399 949 95050 130470999 FALSE SNF HARBOURS EDGE 401 E. LINTON BOULEVARD DELRAY BEACH 33483 TRUE 54 365 217263 703 30901 130471060 FALSE SNF CRYSTAL RIVER HEALTH AND REHABILITATION CENTER 136 NORTHEAST 12TH AVENUE CRYSTAL RIVER 34429 FALSE 150 33,259 217395 725 34203 1195096 FALSE SNF OCALA HEALTH AND REHABILITATION CENTER 1201 SOUTHEAST 24TH ROAD OCALA 34471 FALSE 180 38,922 217727 775 70511 1114096 FALSE SNF WEST MELBOURNE HEALTH & REHABILITATION CENTER 2125 WEST NEW HAVENE AVENUE WEST MELBOURNE 32904 FALSE 180 29,716 217735 705 45504 13850961 FALSE SNF ST AUGUSTINE HEALTH AND REHABILITATION CENTER 51 SUNRISE BOULEVARD SAINT AUGUSTINE 32086 FALSE 120 26,841 217743 730 46404 1593096 FALSE SNF DAYTONA BEACH HEALTH AND REHABILITATION CENTER 1055 THIRD AVENUE DAYTONA BEACH 32117-4196 FALSE 180 39,810 219380 1256 35960944 1516096 FALSE SNF LIFE CARE CENTER OF WINTER HAVEN 1510 CYPRESS GARDENS BOULEVARD WINTER HAVEN 33884 FALSE 177 29,859 220604 1121 11712 11210961 FALSE SNF CENTURY CARE CENTER 6020 INDUSTRIAL BLVD. CENTURY 32535 FALSE 88 23,104 220612 649 15702 130471007 FALSE SNF SANTA ROSA HEALTH & REHABILITATION CENTER 5386 BROAD STEEET MILTON 32570 FALSE 110 27,304 220621 934 15703 16230961 FALSE SNF SANDY RIDGE CARE CENTER 5360 GLOVER LANE MILTON 32570 FALSE 60 13,482 221465 507 33503 1491096 FALSE SNF WESTMINSTER CARE OF CLERMONT 151 EAST MINNEHAHA AVE CLERMONT 34711 FALSE 182 48,093 221589 371 74803 1490096 FALSE SNF WESTMINSTER CARE OF DELANEY PARK 215 ANNIE ST ORLANDO 32806 FALSE 89 14,422 222270 628 24002 1257096 FALSE SNF Crosswinds Health & Rehabilitation Center P.O. BOX 445 GREENVILLE 32331 FALSE 58 16,163 222271 496 23301 11300961 FALSE SNF Cross Landings Health & Rehab Center 1780 N. JEFFERSON ST. Monticello 32344 FALSE 60 15,468 223239 963 111345 12730962 FALSE SNF REGENTS PARK AT AVENTURA 18905 NE 25TH AVENUE AVENTURA 33180 FALSE 180 42,675 223654 446 74805 10310961 FALSE SNF WESTMINSTER CARE OF ORLANDO 830 WEST 29TH STREET ORLANDO 32805 FALSE 391 101,004 223808 544 74809 1384095 FALSE SNF AVANTE AT ORLANDO, INC. 2000 NORTH SEMORAN BOULEVARD ORLANDO 32807 FALSE 118 22,498 224341 843 65305 1156096 FALSE SNF HAINES CITY HEALTH CARE CENTER 409 10TH STREET HAINES CITY 33844 FALSE 120 25,168 225053 907 85810 1190095 FALSE SNF QUALITY HEALTH OF NORTH PORT 6940 OUTREACH WAY NORTH PORT 34287-0947 FALSE 120 24,067 225410 897 74812 1455095 FALSE SNF QUALITY HEALTH OF ORANGE COUNTY 12751 W COLONIAL DR WINTER GARDEN 34787 FALSE 120 20,230 225631 1019 100629 1457096 FALSE SNF SPRINGTREE REHABILITATION & HEALTH CARE CENTER 4251 SPRINGTREE DRIVE SUNRISE 33351-6119 FALSE 110 18,589

Agency for Health Care Administration Burea of Medicaid Program Finance 7 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 225754 626 111334 1456096 FALSE SNF PINECREST CONVALESCENT CENTER 13650 NE THIRD STREET NORTH MIAMI 33161 FALSE 100 22,831 226017 630 100619 15260962 FALSE SNF PLANTATION NURSING & REHABILITATION CENTER 4250 NW 5TH STREET PLANTATION 33317 FALSE 152 8,408 226068 851 41605 1447096 FALSE SNF CATHEDRAL GERONTOLOGY CENTER, INC. 333 EAST ASHLEY STREET JACKSONVILLE 32202 FALSE 120 27,290 226335 390 100603 130470977 FALSE SNF BROWARD NURSING & REHABILITATION CENTER 1330 SOUTH ANDREW AVENUE FORT LAUDERDALE 33316 FALSE 198 40,850 226351 609 46412 1079096 FALSE SNF OCEAN VIEW NURSING & REHABILITATION CENTER 2810 S. ATLANTA AVENUE NEW SMYRNA BEACH 32169 FALSE 239 34,102 226360 657 55245 10670962 FALSE SNF SOUTH HERITAGE HEALTH & REHAB CENTER 718 LAKEVIEW AVENUE SOUTH SAINT PETERSBURG 33705 FALSE 74 18,340 226602 679 111339 13860961 FALSE SNF TREASURE ISLE CARE CENTER 1735 NORTH TREASURE DRIVE NORTH BAY VILLAGE 33141 FALSE 176 53,680 227251 359 55203 1562096 FALSE SNF ALPINE HEALTH & REHABILITATION CENTER 3456 21ST AVENUE SOUTH SAINT PETERSBURG 33711 FALSE 57 17,475 227579 653 100617 1147096 FALSE SNF WILTON MANORS HEALTH & REHABILITATION CENTER 2675 NORTH ANDREWS AVE FORT LAUDERDALE 33311 FALSE 147 30,661 227587 665 70508 10090951 FALSE SNF ROCKLEDGE HEALTH AND REHABILITATION CENTER 587 BARTON BLVD. ROCKLEDGE 32955 FALSE 107 18,084 227625 470 64104 14050963 FALSE SNF GREENBRIAR REHABILITATION AND NURSING CENTER 210 21ST AVENUE WEST BRADENTON 34205 FALSE 79 13,655 227633 671 55224 15340961 FALSE SNF APOLLO HEALTH & REHABILITATION CENTER 1000 24TH STREET NORTH SAINT PETERSBURG 33713 FALSE 99 19,827 227641 603 55236 1182096 FALSE SNF NORTH REHABILITATION CENTER 1301 16TH STREET NORTH SAINT PETERSBURG 33705 FALSE 45 9,859 227765 411 30104 11830962 FALSE SNF PARK MEADOWS HEALTH AND REHABILITATION CENTER 3250 SW 41ST PLACE GAINESVILLE 32608 FALSE 148 35,493 227773 600 34201 1370096 FALSE SNF NEW HORIZON REHABILITATION CENTER 635 SE 17TH STREET OCALA 34471 FALSE 99 22,756 227838 367 41603 1380096 FALSE SNF FIRST COAST HEALTH & REHABILITATION CENTER 7723 JASPER AVENUE JACKSONVILLE 32211 FALSE 100 26,256 227871 796 32101 1637096 FALSE SNF AYERS HEALTH AND REHABILITATION CENTER 606 NE 7TH STREET TRENTON 32693 FALSE 120 22,847 228001 480 111317 1150096 FALSE SNF NORTH BEACH REHABILITATION CENTER 2201 N.E. 170TH STREET NORTH MIAMI BEACH 33160 FALSE 99 26,906 228320 1173 95054 1337096 FALSE SNF GARDENS COURT 3803 PGA BOULEVARD PALM BEACH GARDENS 33410 FALSE 120 17,083 228338 1057 70504 1225096 FALSE SNF LIFE CARE CENTER OF MELBOURNE 606 EAST SHERIDAN STREET MELBOURNE 32901 FALSE 120 14,539 228567 808 55101 12390961 FALSE SNF BEAR CREEK NURSING CENTER 8041 STATE RD. 52 HUDSON 34667 FALSE 120 23,444 228575 801 55108 1256096 FALSE SNF ROYAL OAK NURSING CENTER 37300 ROYAL OAK LANE DADE CITY 33525 FALSE 120 24,390 228591 744 55103 10460962 FALSE SNF HEATHER HILL HEALTHCARE CENTER 6630 KENTUCKY AVENUE NEW PORT RICHEY 34653 FALSE 120 24,267 228621 393 35910176 14840962 FALSE SNF INN AT SARASOTA BAY CLUB 1303 N. TAMIAMI TRAIL SARASOTA 34236 FALSE 44 1,458 228702 471 65304 1217096 FALSE SNF WINTER HAVEN HEALTH & REHABILITATION CENTER 202 AVENUE ^'O^' NE WINTER HAVEN 33881 FALSE 144 36,485 228734 1311 35961056 130471058 FALSE SNF WESTMINSTER BALDWIN PARK 2653 LAKE BALDWIN LANE ORLANDO 32814 TRUE 40 161 228788 434 111358 16370968 FALSE SNF EAST RIDGE RETIREMENT VILLAGE INC 19301 SW 87TH AVENUE MIAMI 33157 TRUE 74 2,954 228940 830 30902 1185096 FALSE SNF CYPRESS COVE CARE CENTER 700 SE 8TH AVENUE CRYSTAL RIVER 34429 FALSE 120 24,248 228958 702 32701 1136096 FALSE SNF BROOKSVILLE HEALTHCARE CENTER 1114 CHATMAN BLVD BROOKSVILLE 34601 FALSE 180 35,877 229202 654 83615 1115096 FALSE SNF SHELL POINT NURSING PAVILION 15000 SHELL POINT BOULEVARD FORT MYERS 33908 TRUE 219 5,198 229220 1312 35961055 1063096 FALSE SNF BRIDGEWATER PARK HEALTH & REHABILITATION CENTER 9280 SOUTH WEST 81ST CT OCALA 34481 FALSE 120 10,873 229610 863 95012 1498095 FALSE SNF LAKE VIEW CARE CENTER AT DELRAY 5430 LINTON BLVD DELRAY BEACH 33484 FALSE 120 16,867 229628 1017 95039 130471062 FALSE SNF MENORAH HOUSE 9945 CENTRAL PARK BLVD BOCA RATON 33428 FALSE 120 21,620 229849 1269 35960961 12300962 FALSE SNF ALEXANDER NININGER STATE VETERANS NURSING HOME 8401 WEST CYPRESS DRIVE PEMBROKE PINES 33025 FALSE 120 10,651 232920 829 22301 1343096 FALSE SNF CROSS SHORES CARE CENTER 220 9TH STREET PORT SAINT JOE 32456 FALSE 120 14,419 233588 821 95033 1521096 FALSE SNF WHITEHALL BOCA RATON 7300 DEL PRADO BOCA RATON 33433 FALSE 154 26,269 233885 818 55212 130471019 FALSE SNF THE CARE CENTER AT PINELLAS PARK 8701 49TH STREET NORTH PINELLAS PARK 33782 FALSE 120 26,739 235832 454 111312 11400961 FALSE SNF SOUTH POINTE PLAZA REHABILITATION AND NURSING CENTER 42 COLLINS AVENUE MIAMI BEACH 33139 FALSE 230 53,608 237766 617 35910286 1171096 FALSE SNF PALMETTO SUB ACUTE CARE CENTER, INC 7600 S.W. 8TH STREET MIAMI 33144 FALSE 95 14,597 242673 742 62937 1295096 FALSE SNF JOHN KNOX VILLAGE MED CENTER 4100 E. FLETCHER AVENUE TAMPA 33613 TRUE 163 19,654 248829 1208 35960897 130470966 FALSE SNF LAKE BENNETT HEALTH AND REHABILITATION CENTER 1901 KELTON AVENUE OCOEE 34761 FALSE 120 23,312 248888 999 35403 1402096 FALSE SNF PALATKA HEALTH CARE CENTER 110 KAY LARKIN DR. PALATKA 32177 FALSE 180 41,519 249749 529 62907 1393096 FALSE SNF SOUTH TAMPA HEALTH AND REHABILITATION CENTER 4610 S. MANHATTAN AVENUE TAMPA 33611 FALSE 160 40,611 249986 1313 35961064 130471063 FALSE SNF OLIVE BRANCH HEALTH AND REHAB CENTER 8325 UNIVERSITY PARKWAY PENSACOLA 32514 FALSE 90 137 250315 799 93104 1573096 FALSE SNF ATLANTIC CARE AND REHABILITATION CENTER 3663 15TH AVENUE VERO BEACH 32960 FALSE 110 20,218 250324 382 65303 1443095 FALSE SNF AUBURNDALE OAKS CARE AND REHABILITATION CENTER 919 OLD WINTER HAVEN ROAD AUBURNDALE 33823 FALSE 120 24,090 250330 846 55209 10860951 FALSE SNF CLEARWATER CARE AND REHABILITATION CENTER 2055 PALMETTO STREET CLEARWATER 33765 FALSE 150 26,841 250334 790 95603 1087096 FALSE SNF LAUREL POINTE CARE AND REHABILITATION CENTER 703 SOUTH 26TH STREET FORT PIERCE 34947 FALSE 107 21,273 250339 1034 41627 1573096 FALSE SNF WEST JACKSONVILLE CARE AND REHABILITATION CENTER 1650 FOURAKER ROAD JACKSONVILLE 32221 FALSE 120 27,224 250906 499 41612 16460962 FALSE SNF PARK RIDGE NURSING CENTER 730 COLLEGE STREET JACKSONVILLE 32204 FALSE 104 24,209 250988 633 111304 1038096 FALSE SNF HIALEAH SHORES NURSING AND REHAB CENTER 8785 NW 32 AVE MIAMI 33147 FALSE 120 23,582 250993 681 46417 1566096 FALSE SNF UNIVERSITY CENTER EAST 991 EAST NEW YORK AVE DELAND 32724 FALSE 60 14,074 250995 682 46418 1567096 FALSE SNF UNIVERSITY CENTER WEST 545 WEST EUCLID AVE DELAND 32720 FALSE 60 17,283 251399 823 65302 1085096 FALSE SNF BRANDYWYNE HEALTH CARE CENTER 1801 NORTH LAKE MARIAM DRIVE WINTER HAVEN 33884 FALSE 120 28,339 251666 409 55215 1399096 FALSE SNF CONCORDIA MANOR 321 13TH AVENUE NORTH SAINT PETERSBURG 33701 FALSE 39 11,214 251673 661 94303 15120961 FALSE SNF STUART NURSING & RESTORATIVE CARE CENTER 1500 PALM BEACH ROAD STUART 34994 FALSE 120 14,854

Agency for Health Care Administration Burea of Medicaid Program Finance 8 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 251721 858 34202 10600961 FALSE SNF OAKHURST REHABILITATION AND NURSING CENTER 1501 SE 24TH ROAD OCALA 34471 FALSE 180 40,119 252018 542 70505 1100096 FALSE SNF AVANTE AT MELBOURNE, INC. 1420 SOUTH OAK STREET MELBOURNE 32901 FALSE 110 19,505 252034 545 46414 13780951 FALSE SNF AVANTE AT ORMOND BEACH, INC. 170 NORTH KINGS ROAD ORMOND BEACH 32174 FALSE 133 19,255 252042 541 33506 13360961 FALSE SNF AVANTE AT MT. DORA, INC. 3050 BROWN AVENUE MOUNT DORA 32757 FALSE 116 24,534 252662 886 85809 13960961 FALSE SNF PINEBROOK REHABILITATION AND NURSING CENTER 1240 PINEBROOK ROAD VENICE 34292 FALSE 120 23,857 252689 838 55104 14390962 FALSE SNF ORCHARD RIDGE REHABILITATION AND NURSING CENTER 4927 VOORHEES ROAD NEW PORT RICHEY 34653 FALSE 120 28,716 253014 810 85813 14250962 FALSE SNF SPRINGWOOD REHABILITATION AND NURSING CENTER 4602 NORTHGATE COURT SARASOTA 34234 FALSE 120 31,003 253430 771 55248 13910962 FALSE SNF SUNSET POINT REHABILITATION AND NURSING CENTER 1980 SUNSET POINT ROAD CLEARWATER 33765 FALSE 120 27,765 253448 809 55206 15130962 FALSE SNF BAY TREE REHABILITATION AND NURSING CENTER 2600 HIGHLANDS BOULEVARD, NORTH PALM HARBOR 34684 FALSE 120 31,404 253456 968 34206 15370961 FALSE SNF HAWTHORNE HEALTH AND REHAB OF OCALA 4100 S.W. 33RD AVENUE OCALA 34474 FALSE 120 18,354 253464 819 55257 10390964 FALSE SNF WEST BAY REHABILITATION AND NURSING CENTER 3865 TAMPA ROAD OLDSMAR 34677 FALSE 120 28,448 253481 1025 100631 1541096 FALSE SNF FORUM AT DEER CREEK 3001 DEER CREEK BLVD DEERFIELD BEACH 33442 FALSE 60 5,839 253707 690 26501 1591096 FALSE SNF EDEN SPRINGS NURSING AND REHAB CENTER 4679 CRAWFORDVILLE HIGHWAY CRAWFORDVILLE 32326 FALSE 120 29,042 253723 498 111322 1162096 FALSE SNF JACKSON PLAZA NURSING & REHABILITATION CENTER 1861 NW 8TH AVE. MIAMI 33136 FALSE 120 28,260 254177 528 100613 1582096 FALSE SNF MANOR PINES CONVALESCENT CENTER 1701 NE 26TH STREET FORT LAUDERDALE 33305 FALSE 206 33,224 254291 366 111303 1255096 FALSE SNF ARCH PLAZA NURSING & REHABILITATION CENTER 12505 NE 16TH AVENUE NORTH MIAMI 33161 FALSE 98 20,624 254762 699 55260 16270961 FALSE SNF WRIGHTS NURSING AND REHABILITATION CENTER 11300 110TH AVE. NORTH SEMINOLE 33778 FALSE 60 9,553 254878 964 41623 10200961 FALSE SNF EDGEWOOD NURSING CENTER 1771 EDGEWOOD AVENUE WEST JACKSONVILLE 32208 FALSE 60 15,029 256269 1004 30906 1614096 FALSE SNF DIAMOND RIDGE HEALTH AND REHABILITATION CENTER 2730 W. MARC KNIGHTON COURT LECANTO 34461 FALSE 142 21,295 256277 986 64110 1272096 FALSE SNF SURREY PLACE HEALTHCARE AND REHABILITATION 5525 21ST AVENUE WEST BRADENTON 34209 FALSE 74 7,385 256757 1222 35960913 15390961 FALSE SNF LAKESIDE NURSING AND REHABILITATION CENTER 1141 ARMSDALE ROAD JACKSONVILLE 32218 FALSE 122 22,152 256846 467 81103 1542096 FALSE SNF LAKESIDE PAVILLION REHABILITATION AND NURSING CENTER 2900 TWELFTH STREET NAPLES 34103 FALSE 120 29,602 256935 1001 100632 130470980 FALSE SNF MANOR OAKS NURSING & REHABILITATION CENTER 2121 E. COMMERCIAL BLVD. FORT LAUDERDALE 33308 FALSE 116 18,203 258342 607 55237 12840962 FALSE SNF OAK MANOR HEALTHCARE & REHABILITATION CENTER 3500 OAK MANOR LANE LARGO 33774 FALSE 180 32,351 258750 947 46421 1640096 FALSE SNF INDIGO MANOR 595 WILLIAMSON BLVD DAYTONA BEACH 32114 FALSE 173 21,989 258831 476 11705 1376096 FALSE SNF HAVEN OF OUR LADY OF PEACE 1900 SUMMIT BOULEVARD PENSACOLA 32503 FALSE 120 18,550 259080 1272 35960976 1248096 FALSE SNF LIFE CARE CENTER AT INVERRARY 4251 ROCK ISLAND ROAD LAUDERHILL 33319 FALSE 120 20,483 259331 1273 35960972 11970951 FALSE SNF UNIHEALTH POST-ACUTE CARE - SANTA ROSA 5530 NORTHROP ROAD MILTON 32570 FALSE 120 25,013 259357 1274 35960969 130471022 FALSE SNF LIFE CARE CENTER OF NEW PORT RICHEY 7400 TROUBLE CREEK ROAD NEW PORT RICHEY 34653 FALSE 113 13,562 259462 1011 62934 130471024 FALSE SNF NURSING CENTER AT UNIVERSITY VILLAGE, THE 12250 NORTH 22ND STREET TAMPA 33612 TRUE 120 16,441 259586 879 95029 130471023 FALSE SNF HAMLIN PLACE 2180 HYPOLUXO ROAD LANTANA 33462 FALSE 120 24,463 259870 546 74905 15690961 FALSE SNF AVANTE AT ST CLOUD, INC. 1301 KANSAS AVANUE SAINT CLOUD 34769-5999 FALSE 131 23,506 260355 485 85818 1474095 FALSE SNF SARASOTA MEMORIAL NURSING AND REHABILITATION CENTER 5640 RAND BLVD. SARASOTA 34238-5174 FALSE 120 14,565 260371 387 46401 1518096 FALSE SNF BRIDGEVIEW CENTER 350 SOUTH RIDGEWOOD AVENUE ORMOND BEACH 32174 FALSE 139 35,061 260444 733 33507 12310961 FALSE SNF BAYVIEW CENTER 301 SOUTH BAY STREET EUSTIS 32726 FALSE 120 29,581 260452 798 33501 10590961 FALSE SNF RULEME CENTER 2810 RULEME STREET EUSTIS 32726 FALSE 138 30,199 260568 794 55253 1382096 FALSE SNF TIERRA PINES CENTER 7380 ULMERTON ROAD LARGO 33771 FALSE 120 37,881 260576 978 65315 11450961 FALSE SNF HIGHLANDS LAKE CENTER 4240 LAKELAND HIGHLANDS ROAD LAKELAND 33813 FALSE 179 40,569 260649 960 46422 15580961 FALSE SNF COQUINA CENTER 170 N. CENTER STREET ORMOND BEACH 32174 FALSE 120 23,943 260657 991 75907 1345096 FALSE SNF ISLAND LAKE CENTER 155 LANDOVER PLACE LONGWOOD 32750 FALSE 120 29,042 260665 1007 70513 13470961 FALSE SNF INDIAN RIVER CENTER 7201 GREENSBORO DRIVE WEST MELBOURNE 32904 FALSE 179 49,169 260673 647 41607 13460963 FALSE SNF RIVERWOOD CENTER 2802 PARENTAL HOME DR JACKSONVILLE 32216 FALSE 240 65,822 260690 724 62919 1348096 FALSE SNF FAIRWAY OAKS CENTER 13806 N. 46TH STREET TAMPA 33613 FALSE 120 29,233 260771 1036 111350 1131095 FALSE SNF SINAI PLAZA NURSING & REHAB CENTER 201 NE 112TH STREET MIAMI 33161 FALSE 150 38,471 261254 356 55202 1613096 FALSE SNF ALHAMBRA HEALTH AND REHABILITATION CENTER 7501 38TH AVENUE NORTH SAINT PETERSBURG 33710 FALSE 60 10,304 261611 612 74810 15190961 FALSE SNF TERRA VISTA REHAB AND HEALTH CENTER 1730 LUCERNE TERRACE ORLANDO 32806 FALSE 115 27,260 261629 676 31201 1006096 FALSE SNF AVALON HEALTHCARE CENTER 1270 SW MAIN BLVD LAKE CITY 32025 FALSE 95 25,461 261637 952 95605 1395096 FALSE SNF EMERALD HEALTH CARE CENTER 1655 SE WALTON ROAD PORT SAINT LUCIE 34952 FALSE 120 19,899 261670 1138 62933 15510961 FALSE SNF HAWTHORNE HEALTH AND REHAB OF BRANDON 851 WEST LUMSDEN ROAD BRANDON 33511 FALSE 132 16,290 263389 1154 70519 14940961 FALSE SNF ATLANTIC SHORES NURSING AND REHAB CENTER 4251 STACK BLVD. MELBOURNE 32901 FALSE 120 21,151 263443 384 22302 16310961 FALSE SNF BONIFAY NURSING AND REHAB CENTER 306 WEST BROCK AVENUE BONIFAY 32425 FALSE 180 48,550 263451 967 64108 16420951 FALSE SNF RIVIERA PALMS REHABILITATION CENTER 926 HABEN BLVD. PALMETTO 34221 FALSE 120 28,347 263460 615 95027 10570961 FALSE SNF BOYNTON BEACH REHABILITATION CENTER 9600 LAWRENCE ROAD BOYNTON BEACH 33436 FALSE 168 36,766 263478 944 30905 14610962 FALSE SNF ARBOR TRAIL REHAB AND SKILLED NURSING CENTER 611 TURNER CAMP ROAD INVERNESS 34453 FALSE 116 23,062 263486 694 55258 14590961 FALSE SNF PINELLAS POINT NURSING AND REHAB CENTER 5601 31ST STREET NORTH SAINT PETERSBURG 33712 FALSE 60 15,683 263494 1037 41626 1220096 FALSE SNF JACKSONVILLE NURSING AND REHAB CENTER 4134 DUNN AVE. JACKSONVILLE 32218 FALSE 163 43,633

Agency for Health Care Administration Burea of Medicaid Program Finance 9 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 263508 1075 46424 16060961 FALSE SNF PORT ORANGE NURSING AND REHAB CENTER 5600 VICTORY GARDENS BLVD. PORT ORANGE 32127 FALSE 120 17,030 263516 1029 40202 13500963 FALSE SNF MACCLENNY NURSING AND REHAB CENTER 755 SOUTH 5TH STREET MACCLENNY 32063 FALSE 120 28,800 263524 536 95025 130471000 FALSE SNF MEDICANA NURSING AND REHAB CENTER 1710 LAKE WORTH ROAD LAKE WORTH 33460 FALSE 117 22,710 263532 1098 95607 1222096 FALSE SNF TIFFANY HALL NURSING AND REHAB CENTER 1800 SE HILLMOOR DRIVE PORT SAINT LUCIE 34952 FALSE 120 26,471 263541 1128 74826 1338096 FALSE SNF METRO WEST NURSING AND REHAB CENTER 5900 WEST GATE DRIVE ORLANDO 32835 FALSE 120 25,476 263559 926 45506 15590961 FALSE SNF MOULTRIE CREEK NURSING AND REHAB CENTER 200 MARINER HEALTH WAY SAINT AUGUSTINE 32086 FALSE 120 21,696 263567 1048 46423 16240961 FALSE SNF ORANGE CITY NURSING AND REHAB CENTER 2810 ENTERPRISE ROAD DEBARY 32713 FALSE 120 22,559 263575 376 62902 14600961 FALSE SNF BAYSHORE POINTE NURSING AND REHAB CENTER 3117 WEST GANDY BLVD. TAMPA 33611 FALSE 117 22,496 263583 1097 70515 1464096 FALSE SNF ROYAL OAKS NURSING AND REHAB CENTER 2225 KNOX MCRAE DRIVE TITUSVILLE 32780 FALSE 120 18,085 263591 1129 75909 10410962 FALSE SNF TUSKAWILLA NURSING AND REHAB CENTER 1024 WILLA SPRINGS DRIVE WINTER SPRINGS 32708 FALSE 98 16,108 263605 1231 35960916 14650962 FALSE SNF HUNTERS CREEK NURSING AND REHAB CENTER 14155 TOWN LOOP BOVD. ORLANDO 32837 FALSE 116 25,344 263613 386 95004 1625096 FALSE SNF BOULEVARD MANOR NURSING AND REHAB CENTER 2839 SOUTH SEACREST BOULEVARD BOYNTON BEACH 33435-7994 FALSE 167 36,216 263621 1103 94305 130470987 FALSE SNF PALM CITY NURSING & REHAB CENTER 2505 SW MARTIN HIGHWAY PALM CITY 34990 FALSE 120 24,913 263834 876 55204 1058096 FALSE SNF BAY POINTE NURSING PAVILION 4201 31ST STREET SOUTH SAINT PETERSBURG 33712 FALSE 120 33,300 263842 383 95003 14630961 FALSE SNF BOCA RATON REHABILITATION CENTER 755 MEADOWS ROAD BOCA RATON 33486 FALSE 120 30,103 263851 414 100605 10360962 FALSE SNF BROWARD INSTITUTE FOR LONG TERM CARE 401 EAST SAMPLE ROAD POMPANO BEACH 33064 FALSE 194 43,758 263869 743 83602 1054096 FALSE SNF REHAB AND HEALTHCARE CENTER OF CAPE CORAL 2629 DEL PRADO BLVD CAPE CORAL 33904 FALSE 120 24,543 263877 931 62920 10960962 FALSE SNF CARROLLWOOD CARE CENTER 15002 HUTCHINSON ROAD TAMPA 33625 FALSE 120 24,722 263885 734 64102 1233096 FALSE SNF CASA MORA REHAB. & EXTENDED CARE 1902 59TH ST WEST BRADENTON 34209 FALSE 240 61,564 263893 803 32703 1077095 FALSE SNF EVERGREEN WOODS 7045 EVERGREEN WOODS TRAIL SPRING HILL 34608 FALSE 120 19,688 263907 482 55227 11660961 FALSE SNF HIGHLAND PINES REHABILITATION CENTER 1111 SOUTH HIGHLAND AVE CLEARWATER 33756 FALSE 120 32,254 263915 412 95005 1146096 FALSE SNF REHABILITATION CENTER OF THE PALM BEACHES,THE 301 NORTHPOINT PARKWAY WEST PALM BEACH 33407 FALSE 109 20,558 263923 407 100604 12280961 FALSE SNF POMPANO REHABILITATION & NURSING CENTER 51 WEST SAMPLE ROAD POMPANO BEACH 33064 FALSE 127 35,473 263931 648 75906 1470096 FALSE SNF HEALTHCARE & REHAB OF SANFORD 950 MELLONVILLE AVENUE SANFORD 32771 FALSE 114 29,385 263940 537 62908 1097096 FALSE SNF REHABILITATION AND HEALTHCARE CENTER OF TAMPA 4411 NORTH HABANA AVE. TAMPA 33614-7299 FALSE 174 42,464 263958 350 55201 1232096 FALSE SNF ABBEY REHABILITATION AND NURSING CENTER 7101 9TH ST. NORTH SAINT PETERSBURG 33702 FALSE 152 36,304 263966 1082 62804 12340961 FALSE SNF OAKS AT AVON 1010 US 27 N AVON PARK 33825 FALSE 104 21,061 263974 677 70509 10010961 FALSE SNF TITUSVILLE REHABILITATION & NURSING CENTER 1705 JESS PARRISH COURT TITUSVILLE 32796 FALSE 157 30,084 263982 432 85803 1557096 FALSE SNF SARASOTA HEALTH AND REHABILITATION CENTER 1524 EAST AVENUE S SARASOTA 34239 FALSE 169 36,993 263991 933 55113 1561096 FALSE SNF WINDSOR WOODS REHABILITATION AND HEALTHCARE CENTER 13719 DALLAS DRIVE HUDSON 34667 FALSE 103 22,312 264008 1141 83613 11350961 FALSE SNF WINKLER COURT 3250 WINKLER AVE FORT MYERS 33916 FALSE 120 25,886 264491 1277 35960985 16090961 FALSE SNF CLIFFORD CHESTER SIMS STATE VETERANS NURSING HOME 4419 TRAM ROAD SPRINGFIELD 32404 FALSE 120 10,366 264512 1061 74821 16300961 FALSE SNF CONWAY LAKES HEALTH & REHABILITATION CENTER 5201 CURRY FORD ROAD ORLANDO 32812 FALSE 120 17,888 264521 792 55208 130471027 FALSE SNF BELLEAIR HEALTH CARE CENTER 1150 PONCE DE LEON BLVD CLEARWATER 33756 FALSE 120 19,353 264539 1024 55267 11020963 FALSE SNF EAST BAY NURSING CENTER 4470 EAST BAY DRIVE CLEARWATER 33764 FALSE 120 21,828 264547 987 70512 10480962 FALSE SNF MELBOURNE TERRACE REHABILITATION CENTER 251 FLORIDA AVE MELBOURNE 32901 FALSE 170 18,302 264563 939 23705 11340962 FALSE SNF CENTRE POINTE HEALTH AND REHAB CENTER 2255 CENTERVILLE ROAD TALLAHASSEE 32308 FALSE 140 18,379 264571 1045 65316 13400962 FALSE SNF SPRING LAKE REHABILITATION CENTER 1540 SIXTH STREET, NW WINTER HAVEN 33881 FALSE 132 12,656 265381 1278 35960987 10810962 FALSE SNF LIFE CARE CENTER OF ESTERO 3850 WILLIAMS ROAD ESTERO 33928 FALSE 155 25,619 265560 710 65311 15110961 FALSE SNF VALENCIA HILLS HEALTH AND REHABILITATION CENTER 1350 SLEEPY HILL ROAD LAKELAND 33810 FALSE 249 52,844 265730 481 111318 130471026 FALSE SNF HIALEAH CONVALESCENT HOME 190 W. 28TH STREET HIALEAH 33010 FALSE 276 77,551 266108 1243 35960931 1280096 FALSE SNF LIFE CARE CENTER OF OCALA 2800 SW 41ST STREET OCALA 34474 FALSE 120 19,697 266124 495 95035 1227096 FALSE SNF LAKE WORTH MANOR 1201 12TH AVENUE SOUTH LAKE WORTH 33460 FALSE 120 26,387 266612 685 62909 130470993 FALSE SNF WHISPERING OAKS 1514 CHELSEA ST TAMPA 33610 FALSE 240 70,807 267724 526 55284 13010961 FALSE SNF SPRINGS AT BOCA CIEGA BAY 1255 PASADENA AVENUE S. SAINT PETERSBURG 33707 FALSE 109 17,224 267902 1132 111355 13830961 FALSE SNF NURSING CENTER AT MERCY 3671 SOUTH MIAMI AVENUE MIAMI 33133 FALSE 120 17,829 268062 888 111338 13040961 FALSE SNF SUSANNA WESLEY HEALTH CENTER 5300 WEST 16TH AVE HIALEAH 33012 FALSE 120 24,052 268186 1281 35960988 1627096 FALSE SNF LIFE CARE CENTER OF PALM BAY 175 VILLANUEVA ROAD PALM BAY 32907 FALSE 141 24,163 268585 1225 35960921 1235096 FALSE SNF HARBORCHASE OF NAPLES 7801 AIRPORT PULLING ROAD NAPLES 34109 FALSE 40 3,907 268755 351 95601 130471030 FALSE SNF ABBIEJEAN RUSSELL CARE CENTER LLC 700 SOUTH 29TH STREET FORT PIERCE 34947 FALSE 79 16,375 268763 353 36101 130470984 FALSE SNF GOOD SAMARITAN CENTER 10676 MARVIN JONES BOULEVARD LIVE OAK 32060 FALSE 161 46,050 268780 936 85817 10020961 FALSE SNF SPRINGS AT LAKE POINTE WOODS 3280 LAKE POINTE DRIVE SARASOTA 34231 FALSE 119 22,335 269000 777 46428 1178096 FALSE SNF JOHN KNOX VILLAGE MEDICAL CENTER-ORANGE CITY 901 VETERANS MEMORIAL PARKWAY ORANGE CITY 32763 TRUE 150 20,738 269492 1280 35960995 12590961 FALSE SNF DOUGLAS JACOBSON STATE VETERANS NURSING HOME 21281 GRAYSTON TERRANCE PORT CHARLOTTE 33954 FALSE 120 16,105 269697 1009 100628 1249095 FALSE SNF REGENTS PARK OF SUNRISE 9711 WEST OAKLAND PARK BLVD SUNRISE 33351 FALSE 120 30,188 269719 983 74819 130471029 FALSE SNF REGENTS PARK OF WINTER PARK 558 SEMORAN BLVD WINTER PARK 32792 FALSE 120 27,587

Agency for Health Care Administration Burea of Medicaid Program Finance 10 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 269727 913 41614 1044096 FALSE SNF REGENTS PARK OF JACKSONVILLE 8700 AC SKINNER PARKWAY JACKSONVILLE 32256 FALSE 120 28,993 281743 456 55229 1469096 FALSE SNF JACARANDA MANOR 4250 66TH STREET NORTH SAINT PETERSBURG 33709 FALSE 299 90,050 282359 982 111348 1467096 FALSE SNF WEST GABLES HEALTH CARE CENTER 2525 SW 75TH AVENUE MIAMI 33155 FALSE 120 11,439 282464 397 46416 1252096 FALSE SNF RIDGECREST NURSING AND REHABILITATION CENTER 1200 NORTH STONE STREET DELAND 32720 FALSE 146 33,842 282529 1153 111356 1592096 FALSE SNF CORAL REEF NURSING & REHABILITATION CENTER 9869 S.W. 152ND STREET MIAMI 33157 FALSE 180 29,978 283193 1284 35961007 1475096 FALSE SNF LIFE CARE CENTER OF JACKSONVILLE 4813 LENOIR AVENUE JACKSONVILLE 32216 FALSE 120 15,471 284289 1180 35960864 1641096 FALSE SNF LIFE CARE CENTER OF ORANGE PARK 2145 KINGSLEY AVENUE ORANGE PARK 32073 FALSE 180 31,034 284793 1255 35960943 130471033 FALSE SNF BRIGHTON GARDENS OF TAMPA 14624 NORTH DALE MABRY HIGHWAY TAMPA 33618 FALSE 45 2,675 308251 551 111308 130471006 FALSE SNF PONCE PLAZA NURSING & REHABILITATION CENTER 355 SW 12TH AVENUE MIAMI 33130 FALSE 147 35,150 310841 767 55289 1218095 FALSE SNF SAINT MARK VILLAGE 2655 NEBRASKA AVENUE PALM HARBOR 34684 TRUE 80 12,655 311685 632 80803 1522096 FALSE SNF LIFE CARE CENTER OF PUNTA GORDA 450 SHREVE STREET PUNTA GORDA 33950 FALSE 180 35,378 312142 511 35401 1507096 FALSE SNF LAKEWOOD NURSING CENTER 100 NORTH LAKE STREET CRESCENT CITY 32112 FALSE 92 20,872 312274 718 35402 12940961 FALSE SNF CRESTWOOD NURSING CENTER 501 SOUTH PALM AVENUE PALATKA 32177 FALSE 65 13,169 312312 1135 95045 12810961 FALSE SNF SAVANNAH COVE 2090 NORTH CONGRESS AVENUE WEST PALM BEACH 33401 FALSE 30 4,062 312550 1144 74827 1454096 FALSE SNF SAVANNAH COVE 1301 W. MAITLAND BLVD MAITLAND 32751 FALSE 39 3,766 312789 1078 100633 16290951 FALSE SNF CHILDRENS COMPREHENSIVE CARE CENTER INC 200 S.E. 19TH AVENUE POMPANO BEACH 33060 FALSE 36 10,915 313718 524 75905 1635096 FALSE SNF LUTHERAN HAVEN NURSING HOME 2041 W. STATE RD. 426 OVIEDO 32765 FALSE 56 7,300 315664 1288 35961009 130470997 FALSE SNF LIFE CARE CENTER OF PENSACOLA 3291 EAST OLIVE ROAD PENSACOLA 32514 FALSE 120 19,336 316628 465 55223 1300096 FALSE SNF LAURELLWOOD NURSING CENTER 3127 - 57TH AVENUE NORTH SAINT PETERSBURG 33714 FALSE 60 14,120 316636 1179 35960855 130471037 FALSE SNF HARBOURWOOD HEALTH AND REHAB CENTER 2855 GULF TO BAY BOULEVARD, BUILDING #31 CLEARWATER 33759 FALSE 120 28,744 317349 420 95007 1538096 FALSE SNF DARCY HALL OF LIFE CARE 2170 PALM BEACH LAKES BLVD. WEST PALM BEACH 33409 FALSE 220 44,467 318795 974 100639 15310961 FALSE SNF COURT AT PALM AIRE, THE 2701 NORTH COURSE DRIVE POMPANO BEACH 33069 FALSE 60 7,405 319244 1260 35960954 1120096 FALSE SNF PALMER RANCH HEALTHCARE AND REHABILITATION 5111 PALMER RANCH PARKWAY SARASOTA 34238 FALSE 60 6,676 319325 881 80802 15550962 FALSE SNF PORT CHARLOTTE REHABILITATION CENTER 25325 RAMPART BLVD PORT CHARLOTTE 33983 FALSE 152 18,723 319376 1185 41631 130471010 FALSE SNF ATRIUM HEALTHCARE CENTER 9960 REGENCY SQUARE BOULEVARD NORTH JACKSONVILLE 32225 FALSE 84 8,012 320391 700 55111 14260961 FALSE SNF ZEPHYR HAVEN HEALTH & REHAB CENTER, INC 38250 A AVENUE ZEPHYRHILLS 33542 FALSE 120 28,859 320404 1234 35960923 1648096 FALSE SNF ZEPHYRHILLS HEALTH & REHAB CENTER, INC 7350 DAIRY ROAD ZEPHYRHILLS 33540 FALSE 113 19,361 320412 1086 74823 16150961 FALSE SNF SUNBELT HEALTH & REHAB CENTER-APOPKA, INC 305 E. OAK STREET APOPKA 32703 FALSE 120 18,998 320421 1092 74822 130470988 FALSE SNF EAST ORLANDO HEALTH & REHAB CENTER, INC 250 S. CHICKASAW TRAIL ORLANDO 32825-3308 FALSE 120 22,202 320439 1264 35960956 1528096 FALSE SNF ADVENTIST CARE CENTERS-COURTLAND, INC 730 COURTLAND STREET ORLANDO 32804 FALSE 120 19,828 320463 445 75901 15290961 FALSE SNF FLNC, INC 3355 E. SEMORAN BLVD. APOPKA 32703 FALSE 222 48,498 320978 911 83603 130471014 FALSE SNF LEHIGH ACRES HEALTH AND REHABILITATION CENTER 1550 LEE BOULEVARD LEHIGH ACRES 33936 FALSE 128 27,577 323772 413 111307 11550962 FALSE SNF CORAL GABLES NURSING AND REHABILITATION CENTER 7060 SW 8TH STREET MIAMI 33144 FALSE 87 21,053 323781 1033 85819 11120951 FALSE SNF TARPON POINT NURSING AND REHABILITATION CENTER 5157 PARK CLUB DRIVE SARASOTA 34235 FALSE 120 33,040 323799 912 20304 1103096 FALSE SNF ST ANDREWS BAY SKILLED NURSING AND REHABILITATION CENTER 2100 JENKS AVE PANAMA CITY 32405 FALSE 120 24,940 324027 1041 111352 1492096 FALSE SNF HAMPTON COURT NURSING AND REHABILITATION CENTER 16100 NW 2ND AVENUE NORTH MIAMI BEACH 33169 FALSE 120 21,794 324213 483 62801 1366095 FALSE SNF ROYAL CARE OF AVON PARK 1213 W. STRATFORD RD. AVON PARK 33825 FALSE 90 17,373 324345 910 64105 11930952 FALSE SNF HERITAGE PARK CARE AND REHABILITATION CENTER 2302 59TH STREET WEST BRADENTON 34209-7009 FALSE 120 17,928 324353 804 26701 12290951 FALSE SNF WASHINGTON REHABILITATION AND NURSING CENTER 879 USERY ROAD/POST OFFICE BOX 917 CHIPLEY 32428 FALSE 180 47,082 324361 752 16601 1226095 FALSE SNF CHAUTAUQUA REHABILITATION AND NURSING CENTER 785 SOUTH 2ND STREET DEFUNIAK SPRINGS 32433 FALSE 180 31,086 324370 785 83605 1065096 FALSE SNF SIGNATURE HEALTHCARE AT COLLEGE PARK 13755 GOLF CLUB PARKWAY FORT MYERS 33919 FALSE 107 22,382 324388 639 30102 1583096 FALSE SNF SIGNATURE HEALTHCARE OF GAINESVILLE 4000 SOUTH WEST 20TH AVENUE GAINESVILLE 32607 FALSE 120 27,773 324396 757 23201 1159096 FALSE SNF SIGNATURE HEALTHCARE OF NORTH FLORIDA 1083 SANDERS AVENUE GRACEVILLE 32440 FALSE 180 46,348 324400 930 111341 1170096 FALSE SNF SIGNATURE HEALTHCARE CENTER OF WATERFORD 8333 W. OKEECHOBEE ROAD HIALEAH GARDENS 33016 FALSE 214 56,266 324418 932 111342 1253096 FALSE SNF SIGNATURE HEALTHCARE OF BROOKWOOD GARDENS 1990 S. CANAL DRIVE HOMESTEAD 33035 FALSE 180 23,228 324426 1206 35960891 1586096 FALSE SNF SIGNATURE HEALTHCARE AT THE COURTYARD 2600 FOREST GLEN TRAIL MARIANNA 32446 FALSE 120 30,655 324434 778 41003 1064096 FALSE SNF SIGNATURE HEALTHCARE OF ORANGE PARK 2029 PROFESSIONAL CENTER DRIVE ORANGE PARK 32073 FALSE 105 22,230 324442 848 46415 130470975 FALSE SNF SIGNATURE HEALTHCARE OF ORMOND 103 N. CLYDE MORRIS BLVD ORMOND BEACH 32174 FALSE 60 9,775

Agency for Health Care Administration Burea of Medicaid Program Finance 11 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 324451 852 70507 13900961 FALSE SNF ANCHOR CARE AND REHABILITATION CENTER 1515 PORT MALABAR BLVD. NE PALM BAY 32905-5455 FALSE 120 26,612 324477 761 80804 1397096 FALSE SNF SIGNATURE HEALTHCARE OF PORT CHARLOTTE 4033 BEAVER LANE PORT CHARLOTTE 33952 FALSE 164 31,181 324493 747 62803 14040951 FALSE SNF KENILWORTH CARE & REHABILITATION CENTER 3011 KENILWORTH BLVD. SEBRING 33870 FALSE 104 16,501 324507 847 55240 1085096 FALSE SNF PENINSULA CARE AND REHABILITATION CENTER 900 BECKETT WAY TARPON SPRINGS 34689 FALSE 120 31,629 324515 735 74816 14510962 FALSE SNF WINTER PARK CARE & REHABILITATION CENTER 2970 SCARLET ROAD WINTER PARK 32792 FALSE 103 25,229 325236 1012 41624 1495096 FALSE SNF HEARTLAND HEALTH CARE CENTER JACKSONVILLE 8495 NORMANDY BLVD JACKSONVILLE 32221 FALSE 120 16,589 325261 1018 41005 1082095 FALSE SNF HEARTLAND HEALTH CARE CENTER ORANGE PARK 570 WELLS ROAD ORANGE PARK 32073 FALSE 120 21,165 325287 770 41602 1207095 FALSE SNF HEARTLAND HEALTH CARE CENTER OF SOUTH JACKSONVILLE 3648 UNIVERSITY BOULEVARD JACKSONVILLE 32216 FALSE 117 18,737 325309 1047 95019 1208096 FALSE SNF HEARTLAND HEALTH CARE CENTER BOYNTON BEACH 3600 OLD BOYNTON BEACH BOYNTON BEACH 33436 FALSE 120 30,842 325325 1038 83610 1211096 FALSE SNF HEARTLAND HEALTH CARE CENTER FORT MYERS 1600 MATTHEW DRIVE FORT MYERS 33907 FALSE 120 16,314 325341 1054 95038 1309096 FALSE SNF HEARTLAND HEALTH CARE CENTER PROSPERITY OAKS 11375 PROSPERITY FARMS ROAD PALM BEACH GARDENS 33410 FALSE 120 21,980 325368 859 95021 1210096 FALSE SNF MANORCARE HEALTH SERVICES 375 N W STREET BOCA RATON 33431 FALSE 180 41,155 325376 882 95022 1209096 FALSE SNF MANORCARE HEALTH SERVICES BOYNTON BEACH 3001 S CONGRESS AVE BOYNTON BEACH 33426 FALSE 180 31,881 325384 1261 35960947 1212096 FALSE SNF MANORCARE HEALTH SERVICES 13881 EAGLE RIDGE DRIVE FORT MYERS 33912 FALSE 120 16,533 325422 856 81104 12150962 FALSE SNF MANORCARE AT LELY PALMS 6135 RATTLESNAKE HAMMOCK ROAD NAPLES 34113 FALSE 117 17,309 325449 814 81101 1313096 FALSE SNF MANORCARE NURSING AND REHABILITATION CENTER 3601 LAKEWOOD BLVD NAPLES 34112 FALSE 120 21,449 325465 844 85807 13140962 FALSE SNF MANORCARE HEALTH SERVICES SARASOTA 5511 SWIFT ROAD SARASOTA 34231 FALSE 178 37,468 325473 1211 35960901 12930962 FALSE SNF MANORCARE HEALTH SERVICES 1450 E. VENICE VENICE 34292 FALSE 129 17,945 325481 1156 95046 1311096 FALSE SNF MANORCARE HEALTH SERVICES WEST PALM BEACH 2300 VILLAGE BLVD WEST PALM BEACH 33409 FALSE 120 24,294 325490 457 85806 1317096 FALSE SNF KENSINGTON MANOR 3250 12TH STREET SARASOTA 34237 FALSE 87 16,214 325520 1237 35960928 1318096 FALSE SNF MANORCARE HEALTH SERVICES 16200 JOG ROAD DELRAY BEACH 33446 FALSE 120 19,199 325686 828 55231 1643096 FALSE SNF MANOR CARE HEALTH SERVICES DUNEDIN 870 PATRICIA AVE DUNEDIN 34698 FALSE 120 21,926 325694 1035 55268 12640961 FALSE SNF MANOR CARE HEALTH SERVICES PALM HARBOR 2851 TAMPA RD PALM HARBOR 34684 FALSE 180 31,877 325708 971 55114 130470991 FALSE SNF HEARTLAND OF ZEPHYRHILLS 38220 HENRY DRIVE ZEPHYRHILLS 33540 FALSE 120 22,874 326011 9999 1469 1315096 FALSE SNF MOOSEHAVEN 1701 PARK AVENUE Orange Park 32073 TRUE 74 5,173 1000022 1217 35960905 13120961 FALSE SNF MARTIN NURSING AND RESTORATIVE CARE CENTER 6001 SE TOWER ROAD STUART 34997 FALSE 120 20,805 1002711 916 114403 1446096 FALSE SNF PLANTATION KEY NURSING CENTER 48 HIGH POINT RD TAVERNIER 33070 FALSE 120 19,423 1002777 1023 62923 130470970 FALSE SNF MANORCARE HEALTH SERVICES CARROLLWOOD 3030 W. BEARASS AVENUE TAMPA 33618 FALSE 120 19,473 1002787 732 74802 1452096 FALSE SNF MANOR CARE NURSING & REHABILITATION CENTER 2075 LOCHMOND DRIVE WINTER PARK 32792 FALSE 138 20,064 1002969 1002 100627 1205096 FALSE SNF HEARTLAND HEALTH CARE CENTER LAUDERHILL 2599 NW 55TH AVENUE LAUDERHILL 33313 FALSE 109 28,886 1002974 1031 111349 1310096 FALSE SNF HEARTLAND HEALTH CARE CENTER MIAMI LAKES 5725 NW 186TH STREET HIALEAH 33015 FALSE 120 13,266 1002982 975 100626 16110963 FALSE SNF HEARTLAND OF TAMARAC 5901 NW 79TH AVENUE TAMARAC 33321 FALSE 151 26,709 1002991 898 100612 12060961 FALSE SNF MANORCARE HEALTH SERVICES 6931 W SUNRISE BLVD PLANTATION 33313 FALSE 120 24,314 1002999 984 111347 130471009 FALSE SNF HEARTLAND HEALTH CARE CENTER KENDALL 9400 SW 137TH AVENUE KENDALL 33186 FALSE 120 12,604 1004024 1112 95042 1143095 FALSE SNF STRATFORD COURT OF BOCA RATON 6343 VIA SONRISA DEL SUR BOCA RATON 33433 FALSE 60 5,241 1009647 1314 35961071 1082095 FALSE SNF ADVENTHEALTH CARE CENTER WATERMAN 4501 WATERMAN WAY TAVARES 32778 FALSE 120 7,689 1009887 1315 35961078 130471064 FALSE SNF SCOTT LAKE HEALTH AND REHABILITATION CENTER 800 E COUNTY RD 540A LAKELAND 33813 FALSE 120 6,625 1013748 652 83608 130470976 FALSE SNF SHADY REST CARE PAVILION 2310 NORTH AIRPORT ROAD FORT MYERS 33907 FALSE 180 34,156 1017621 1102 94306 130470964 FALSE SNF WATERS EDGE EXTENDED CARE 1500 S.W. CAPRI PALM CITY 34990 TRUE 56 2,896 1019609 644 55247 1651096 FALSE SNF BAYWOOD NURSING CENTER 2000 17TH AVENUE SOUTH SAINT PETERSBURG 33712 FALSE 59 16,191 1019625 878 55249 11790962 FALSE SNF GRACEWOOD REHABILITATION AND NURSING CARE 8600 U.S. HIGHWAY 19 NORTH PINELLAS PARK 33782 FALSE 120 29,100 1021302 1317 35961063 130471067 FALSE SNF Kendall Lakes Health and Rehabilitation Center 5280 SW 157 Avenue Miami 33185-0000 FALSE 150 12,265 1022071 855 45503 1536096 FALSE SNF PONCE DE LEON CARE CENTER 1999 OLD MOULTRIE ROAD SAINT AUGUSTINE 32086 FALSE 120 16,496 1023109 1114 35961024 130471048 FALSE SNF Barrington Terrace at Boynton Beach 1425 S Congress Ave Boynton Beach 33426-0000 FALSE 29 0 1023546 415 62805 13590961 FALSE SNF PALMS OF SEBRING, THE 725 SOUTH PINE STREET SEBRING 33870 FALSE 120 16,280 1023745 1316 35961066 130471066 FALSE SNF PruittHealth - Panama City 3212 Jenks Avenue Panama City 32405-0000 FALSE 77 257 1030069 369 111316 1650096 FALSE SNF AVENTURA PLAZA REHABILITATION & NURSING CENTER 1800 NE 168TH STREET NORTH MIAMI BEACH 33162 FALSE 86 19,612 1030145 514 65308 12760961 FALSE SNF GRACE HEALTHCARE OF LAKE WALES 730 NORTH SCENIC HIGHWAY LAKE WALES 33853 FALSE 100 16,832 1031622 468 111314 1249095 FALSE SNF Harmony Health Center 9820 N. Kendall Drive Miami 33176-0000 FALSE 203 54,600 1032432 1321 35961077 130471071 FALSE SNF Adventhealth Care Center Celebration 1290 Celebration Boulevard Kissimmee 34747-0000 FALSE 120 7,677 1032910 1320 35961065 130471069 FALSE SNF Viera Del Mar Health and Rehabilitation Center 2355 Vidina Drive Viera 32940-000 FALSE 131 1,273 1036022 439 111309 1147096 FALSE SNF Fair Havens Center 201 Curtiss Parkway Miami Springs 33166-5291 FALSE 269 74,621 1036415 872 44501 130470961 FALSE SNF QUALITY HEALTH OF FERNANDINA BEACH 1625 LIME ST FERNANDINA BEACH 32034 FALSE 120 22,410 1038712 1318 35961024 130471048 FALSE SNF Pruitthealth - Fleming Island 2040 Town Center Blvd Fleming Island 32003-0000 FALSE 97 1,924 1045184 1322 35961074 130471072 FALSE SNF Rehabilitation Center of Lake City, The 298 SW Prosperity PL Lake City 32024-0000 FALSE 113 1,843 1046531 870 111310 1154096 FALSE SNF Golden Glades Nursing and Rehabilitation Center 220 Sierra Drive Miami 33179-0000 FALSE 180 48,412

Agency for Health Care Administration Burea of Medicaid Program Finance 12 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 1046541 890 111313 1180096 FALSE SNF South Dade Nursing and Rehabilitation Center 17475 S Dixie Hwy Miami 33157-0000 FALSE 180 44,044 1047077 604 111324 1334096 FALSE SNF North Dade Nursing and Rehabilitation Center 1255 NE 135th Street North Miami 33161-0000 FALSE 245 64,064 1049235 883 100625 1430095 FALSE SNF The Park Summit at Coral Springs 8500 ROYAL PALM BLVD. Coral Springs 33065 FALSE 35 5,025 1049565 1323 35961088 130471073 FALSE SNF Orlando Health Center for Rehabilitation 1300 Hempel Ave Ocoee 34761-0000 FALSE 110 18,590 1059536 1326 35961087 130471075 FALSE SNF The Lakes of Clermont Health and Rehabilitation Center 1775 Hooks Street Clermont 34711-0000 FALSE 80 5,032 1059598 1329 35961086 130471074 FALSE SNF De Luna Health and Rehabilitation Center 9310 Fowler Ave Pensacola 32514-000 FALSE 90 521 1059993 1327 35961069 130471077 FALSE SNF Dolphin Pointe Health Care Center 5355 Dolphin Point Blvd Jacksonville 32211-0000 FALSE 146 8,516 1062639 1055 65318 13770961 FALSE SNF OAKBRIDGE HEALTHCARE CENTER 3110 OAKBRIDGE BLVD., E. LAKELAND 33803 FALSE 120 17,752 1064829 1332 35961067 130471080 FALSE SNF PRUITTHEALTH - SOUTHWOOD 2301 BLUFF OAK WAY TALLAHASSEE 32311 FALSE 64 1,712 - 117 0 FALSE SNU GULF COAST MEDICAL CENTER SKILLED NURSING UNIT 13960 PLANTATION ROAD FORT MYERS 33912 FALSE 75 0 - 118 0 FALSE SNU ADVENTHEALTH DADE CITY 13100 FORT KING RD DADE CITY 33525 FALSE 45 0 - 108 108 FALSE SNU KINDRED HOSPITAL SOUTH FLORIDA HOLLYWOOD 1859 VAN BUREN ST HOLLYWOOD 33020 FALSE 30 0 - 114 0 FALSE SNU LEE MEMORIAL HOSPITAL SKILLED NURSING UNIT 2276 CLEVELAND AVENUE FORT MYERS 33901 FALSE 18 0 - 106 106 FALSE SNU SKYTOP VIEW REHABILITATION CENTER 2145 N WICHAM DR CLERMONT 34711-1909 FALSE 30 0 - 64 64 FALSE SNU STEWARD SEBASTIAN RIVER MEDICAL CENTER 13695 US 1 SEBASTIAN 32958 FALSE 33 0 - 533 55285 130471057 FALSE SNF MASONIC HOME OF FLORIDA 3201 1ST ST NE ST PETERSBURG 33704 TRUE 85 0 - 619 55292 1316096 FALSE SNF WESTMINSTER PALMS 830 NORTH SHORE DRIVE NE SAINT PETERSBURG 33701 TRUE 42 0 - 631 85827 12160951 FALSE SNF PLYMOUTH HARBOR INCORPORATED 700 JOHN RINGLING BLVD. SARASOTA 34236 TRUE 60 0 - 741 62935 10D0022596 FALSE SNF CANTERBURY TOWERS INC 3501 BAYSHORE BLVD TAMPA 33629-8933 TRUE 60 0 - 807 81108 1422096 FALSE SNF CHATEAU AT MOORINGS PARK, THE 130 MOORINGS PARK DRIVE NAPLES 34105 TRUE 106 0 - 866 95049 1449096 FALSE SNF WILLOWBROOKE COURT AT EDGEWATER POINTE ESTATES 23305 BLUE WATER CIRCLE BOCA RATON 33433 TRUE 101 0 - 909 81107 1072096 FALSE SNF BENTLEY CARE CENTER 875 RETREAT DRIVE NAPLES 34110 TRUE 100 0 - 918 75910 1357096 FALSE SNF VILLAGE ON THE GREEN 500 VILLAGE PLACE LONGWOOD 32779 TRUE 60 0 - 959 93106 1139096 FALSE SNF WILLOWBROOKE COURT AT INDIAN RIVER ESTATES 2200 INDIAN CREEK BLVD WEST VERO BEACH 32966 TRUE 120 0 - 985 45507 1050095 FALSE SNF VICARS LANDING NURSING HOME 1003 YORK ROAD PONTE VEDRA BEACH 32082 TRUE 60 0 - 1014 74828 1579096 FALSE SNF MAYFLOWER HEALTHCARE CENTER 1620 MAYFLOWER COURT WINTER PARK 32792 TRUE 60 0 - 1040 41630 12460962 FALSE SNF FLEET LANDING ONE FLEET LANDING BLVD. ATLANTIC BEACH 32233 TRUE 70 0 - 1101 81109 1328096 FALSE SNF PREMIER PLACE AT THE GLENVIEW 100 GLENVIEW PLACE NAPLES 34108 TRUE 42 0 - 1163 45 45 FALSE SNU HELEN ELLIS MEMORIAL HOSPITAL 1395 S.PINELLAS AVENUE TARPON SPRINGS 34689 FALSE 32 0 - 1203 53 53 FALSE SNU SHANDS JACKSONVILLE MEDICAL CENTER 655 WEST 8TH STREET JACKSONVILLE 32209 FALSE 56 0 - 1249 35960938 0 FALSE SNF CHATSWORTH AT PGA NATIONAL 347 HIATT DRIVE PALM BEACH GARDENS 33418 TRUE 76 0 - 1258 35960952 0 FALSE SNF LODGE AT CYPRESS COVE, THE 10500 CYPRESS COVE DR FORT MYERS 33908 TRUE 64 0 - 1270 35960965 0 FALSE SNF LIFE CARE ST. JOHNS, INC. 230 TOWERVIEW DRIVE SAINT AUGUSTINE 32092 TRUE 30 0 - 1275 35960975 130471003 FALSE SNF FINR III, LLC 1962 VANDOLAH ROAD WAUCHULA 33873 FALSE 25 0 - 1276 102 130471008 FALSE SNU NORTHWEST FLORIDA COMMUNITY HOSPITAL 1360 BRICKYARD ROAD CHIPLEY 32428 FALSE 34 0 - 1282 35960994 130471020 FALSE SNF GLENRIDGE ON PALMER RANCH INC. 7333 SCOTLAND WAY SARASOTA 34238 TRUE 61 0 - 1283 35961003 130471025 FALSE SNF OAK HAMMOCK AT THE UNIVERSITY OF FLORIDA, INC. 2660 SW 53RD LANE GAINESVILLE 32608 TRUE 73 0 - 1285 35961005 0 FALSE SNF NURSING CENTER AT LA POSADA, THE 3600 MASTERPIECE WAY PALM BEACH GARDENS 33410 TRUE 40 0 - 1289 35961002 130471031 FALSE SNF CLASSIC RESIDENCE BY HYATT IN AVENTURA 19333 WEST COUNTRY CLUB DRIVE AVENTURA 33180 TRUE 40 0 - 1292 35961030 130471032 FALSE SNF VILLA MARIA WEST SKILLED NURSING FACILITY 8850 NW 122 ST HIALEAH GARDENS 33018 FALSE 27 0 - 1294 35961027 130471054 FALSE SNF FREEDOM POINTE AT THE VILLAGES REHABILITATION AND HEALTHCARE CTR 1460 EL CAMINO REAL DRIVE THE VILLAGES 32159 TRUE 72 0 - 1305 35961039 130471034 FALSE SNF SPRINGS AT THE TERRACES, THE 26475 S TAMIAMI TR BONITA SPRINGS 34135 TRUE 40 0 - 1307 35961045 130471038 FALSE SNF THE ARLINGTON OF NAPLES, INC. 8000 ARLINGTON CIRCLE NAPLES 34113 TRUE 44 0 - 1308 35961047 130471041 FALSE SNF HEALTH CENTER AT SINAI RESIDENCES 21044 95TH AVENUE SOUTH BOCA RATON 33428 TRUE 60 0 - n/a 35961075 130471070 FALSE SNF GARDENS AT TERRACINA HEALTH & REHABILITATION 6869 DAVIS BLVD NAPLES 34104 FALSE 30 0

Agency for Health Care Administration Burea of Medicaid Program Finance 13 9/25/2020