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NPI Code Detail

MEDICARE: 6305 CORTEZ ROAD WEST OPERATIONS LLC

MEDICARE: 6305 CORTEZ ROAD WEST OPERATIONS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilitySNF130471011FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285903062
Entity Type Code : Organization
Provider Name (Legal Business Name) : 6305 CORTEZ ROAD WEST OPERATIONS LLC
Provider Business Mailing Address
First Line : 6305 CORTEZ RD W
Second Line :
City : BRADENTON
State : FL
Zip : 34210-2604
Country : US
Telephone Number : 941-761-3499
Fax Number : 941-761-8938
Provider Business Practice Location Address
First Line : 6305 CORTEZ RD W
Second Line :
City : BRADENTON
State : FL
Zip : 34210-2604
Country : US
Telephone Number : 941-761-3499
Fax Number : 941-761-8938
Authorized Official
Title or Position : VP
Name : KENNETH USSERY
Credential :
Telephone Number : 407-571-1550
Provider Enumeration Date : 12/22/2011
Last Update Date : 11/27/2023

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1043427685 — MRS. JENNIFER K OELFKE MA, CCC-SLP
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1972873818 — MRS. CARRIE ANN DUNBAR OTR/L
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