MEDICARE: SB SNF OPCO 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
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1811690423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SB SNF OPCO LLC

Provider Business Mailing Address
First Line	:	5679 ROYAL OAK WAY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6386
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16650 W DIXIE HWY
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-3713
Country	:	US
Telephone Number	:	917-608-6734
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDREW BRONFELD
Credential	:
Telephone Number	:	917-608-6734

Provider Enumeration Date	:	03/23/2023
Last Update Date	:	03/23/2023

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