Healthcare Provider Details

I. General information

NPI: 1912975228
Provider Name (Legal Business Name): OHI WEST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2006
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 6TH ST S
ST PETERSBURG FL
33701-4814
US

IV. Provider business mailing address

701 6TH ST S
ST PETERSBURG FL
33701-4814
US

V. Phone/Fax

Practice location:
  • Phone: 727-893-1234
  • Fax: 727-893-6085
Mailing address:
  • Phone: 727-823-1234
  • Fax: 727-893-6085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number4303
License Number StateFL

VIII. Authorized Official

Name: MICHAEL STUBEE
Title or Position: AVP
Credential:
Phone: 407-481-7156