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General NPI Number Information
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NPI Number | 1285903062
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Entity Type | Organization
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Legal Business Name | 6305 CORTEZ ROAD WEST OPERATIONS LLC
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Dates
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Enumeration Date | 12/22/2011
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 6305 CORTEZ RD W
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City | BRADENTON
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State | FL
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Zip | 34210-2604
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Country | US
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Telephone | 941-761-3499
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Fax | 941-761-8938
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Provider Business Mailing Address
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Address Line | 6305 CORTEZ RD W
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City | BRADENTON
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State | FL
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Zip | 34210-2604
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Country | US
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Telephone | 941-761-3499
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Fax | 941-761-8938
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Authorized Official
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Title or Position | VP
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Name | KENNETH USSERY
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Credential |
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Telephone | 407-571-1550
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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 | SNF130471011
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License Number State | FL
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