Healthcare Provider Details

I. General information

NPI: 1841536984
Provider Name (Legal Business Name): OSPREY NURSING AND REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 11/27/2023
Certification Date: 05/15/2020
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: 352-568-8780
Mailing address:
  • Phone: 352-568-8777
  • Fax: 352-568-8780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF130471001
License Number StateFL

VIII. Authorized Official

Name: KENNETH USSERY
Title or Position: VP
Credential:
Phone: 407-571-1550