Healthcare Provider Details

I. General information

NPI: 1982152187
Provider Name (Legal Business Name): RK3, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 54TH AVE S
ST PETERSBURG FL
33711-4664
US

IV. Provider business mailing address

20001 GULF BLVD SUITE 11
INDIAN SHORES FL
33785-2472
US

V. Phone/Fax

Practice location:
  • Phone: 727-581-4648
  • Fax:
Mailing address:
  • Phone: 727-581-4648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: KEVIN RYAN ROCKEFELLER
Title or Position: MANAGING MEMBER
Credential:
Phone: 727-581-4648