Healthcare Provider Details

I. General information

NPI: 1003125329
Provider Name (Legal Business Name): BAYONET POINT REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7210 BEACON WOODS DR
HUDSON FL
34667-1974
US

IV. Provider business mailing address

7210 BEACON WOODS DR
HUDSON FL
34667-1974
US

V. Phone/Fax

Practice location:
  • Phone: 727-863-1521
  • Fax: 727-868-2352
Mailing address:
  • Phone: 727-863-1521
  • Fax: 727-868-2352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN E WARREN
Title or Position: MGR
Credential:
Phone: 727-863-1521