Healthcare Provider Details

I. General information

NPI: 1801648258
Provider Name (Legal Business Name): OSPREY SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 N MAIN ST
BUSHNELL FL
33513-5045
US

IV. Provider business mailing address

1104 N MAIN ST
BUSHNELL FL
33513-5045
US

V. Phone/Fax

Practice location:
  • Phone: 352-568-8777
  • Fax:
Mailing address:
  • Phone: 352-568-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMUEL GUTMAN
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 718-852-7000