Healthcare Provider Details

I. General information

NPI: 1508110909
Provider Name (Legal Business Name): LP ST. PETERSBURG PASADENA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 PASADENA AVE S
SOUTH PASADENA FL
33707-3716
US

IV. Provider business mailing address

12201 BLUEGRASS PKWY
LOUISVILLE KY
40299-2361
US

V. Phone/Fax

Practice location:
  • Phone: 727-344-8525
  • Fax: 855-887-9751
Mailing address:
  • Phone: 502-568-7800
  • 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: JOHN HARRISON
Title or Position: CFO
Credential:
Phone: 502-568-7800