Healthcare Provider Details

I. General information

NPI: 1740949122
Provider Name (Legal Business Name): BC SNF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3875 WEDGEWOOD LN
THE VILLAGES FL
32162-9301
US

IV. Provider business mailing address

200 CLEARWATER LARGO RD S
LARGO FL
33770-3235
US

V. Phone/Fax

Practice location:
  • Phone: 352-674-4800
  • Fax:
Mailing address:
  • Phone: 727-581-4607
  • 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: MR. KEVIN RYAN ROCKEFELLER
Title or Position: OWNER
Credential:
Phone: 904-422-5231