Healthcare Provider Details

I. General information

NPI: 1982240263
Provider Name (Legal Business Name): SANDY RIDGE SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 GLOVER LN
MILTON FL
32570-4189
US

IV. Provider business mailing address

2123 CENTRE POINTE BLVD
TALLAHASSEE FL
32308-4930
US

V. Phone/Fax

Practice location:
  • Phone: 850-626-9225
  • Fax: 850-626-5983
Mailing address:
  • Phone: 850-386-2831
  • Fax: 850-386-2016

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: MR. SOLOMON KLEIN
Title or Position: MANAGER
Credential:
Phone: 347-909-1811