Healthcare Provider Details

I. General information

NPI: 1275732042
Provider Name (Legal Business Name): NEW PORT RICHEY SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 INDIANA AVE
NEW PORT RICHEY FL
34653-3214
US

IV. Provider business mailing address

1835 NE MIAMI GARDENS DR #368
NORTH MIAMI BEACH FL
33179-5035
US

V. Phone/Fax

Practice location:
  • Phone: 727-843-0600
  • Fax: 727-847-0898
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: MR. TZVI BOGOMILSKY
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 305-401-7901