Healthcare Provider Details

I. General information

NPI: 1306467931
Provider Name (Legal Business Name): KEY WEST NURSING HOME OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5860 COLLEGE RD
KEY WEST FL
33040-4314
US

IV. Provider business mailing address

2745 NE 184TH WAY
AVENTURA FL
33160-2083
US

V. Phone/Fax

Practice location:
  • Phone: 914-548-7617
  • Fax:
Mailing address:
  • Phone: 914-548-7617
  • 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: STEVEN BICKY
Title or Position: MANAGER
Credential:
Phone: 914-548-7617