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General NPI Number Information
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NPI Number | 1043265416
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Entity Type | Organization
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Legal Business Name | BRANDON HEALTH CARE ASSOCIATES LLC
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 02/15/2013
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Provider Practice Location Address
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Address Line | 1465 OAKFIELD DR
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City | BRANDON
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State | FL
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Zip | 33511-4854
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Country | US
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Telephone | 813-655-0404
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Fax | 813-654-9589
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Provider Business Mailing Address
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Address Line | 1465 OAKFIELD DR
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City | BRANDON
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State | FL
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Zip | 33511-4854
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Country | US
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Telephone | 813-655-0404
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Fax | 813-654-9589
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Authorized Official
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Title or Position | MANAGER
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Name | BRIAN M. KUELL
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Credential |
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Telephone | 813-655-0404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | SNF130470969
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License Number State | FL
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