Healthcare Provider Details

I. General information

NPI: 1407879307
Provider Name (Legal Business Name): WEST PALM BEACH FACILITY OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 11/27/2023
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 DAVIS RD
WEST PALM BEACH FL
33406-5640
US

IV. Provider business mailing address

1626 DAVIS RD
WEST PALM BEACH FL
33406-5640
US

V. Phone/Fax

Practice location:
  • Phone: 561-439-8897
  • Fax: 561-439-4562
Mailing address:
  • Phone: 561-439-8897
  • Fax: 561-439-4562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF15950961
License Number StateFL

VIII. Authorized Official

Name: KENNETH USSERY
Title or Position: VP
Credential:
Phone: 407-571-1550