Healthcare Provider Details

I. General information

NPI: 1871779215
Provider Name (Legal Business Name): PENSACOLA SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W GREGORY ST
PENSACOLA FL
32502-4744
US

IV. Provider business mailing address

368 NEW HEMPSTEAD RD # 309
NEW CITY NY
10956-1900
US

V. Phone/Fax

Practice location:
  • Phone: 850-437-3131
  • 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
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: JACOB KARMEL
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 516-209-2287