Healthcare Provider Details

I. General information

NPI: 1497473763
Provider Name (Legal Business Name): BG SNF OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 LPGA BLVD
HOLLY HILL FL
32117-3113
US

IV. Provider business mailing address

3389 SHERIDAN ST # 11
HOLLYWOOD FL
33021-3606
US

V. Phone/Fax

Practice location:
  • Phone: 386-226-9000
  • Fax:
Mailing address:
  • Phone:
  • 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: DANIEL ROTH
Title or Position: CFO
Credential:
Phone: 847-275-2940