Healthcare Provider Details

I. General information

NPI: 1891444865
Provider Name (Legal Business Name): PINELLAS PARK FL OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 49TH ST N
PINELLAS PARK FL
33782-5331
US

IV. Provider business mailing address

23645 MERCANTILE RD STE J
BEACHWOOD OH
44122-5936
US

V. Phone/Fax

Practice location:
  • Phone: 727-546-4661
  • Fax:
Mailing address:
  • Phone: 212-444-1991
  • 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: DAVID HERSKOWITZ
Title or Position: CHIEF OF STAFF
Credential:
Phone: 212-444-1991