Healthcare Provider Details

I. General information

NPI: 1326984873
Provider Name (Legal Business Name): KISSIMMEE SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 ALDERSGATE DR
KISSIMMEE FL
34746-6573
US

IV. Provider business mailing address

1550 ALDERSGATE DR
KISSIMMEE FL
34746-6573
US

V. Phone/Fax

Practice location:
  • Phone: 407-846-7201
  • 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: ROB MANELA
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 954-774-7412