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General NPI Number Information
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NPI Number | 1588870778
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Entity Type | Organization
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Legal Business Name | SCG PALAZZO OPERATOR, LLC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 3600 34TH ST S
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City | ST PETERSBURG
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State | FL
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Zip | 33711-3800
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Country | US
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Telephone | 727-867-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 34TH ST S
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City | ST PETERSBURG
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State | FL
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Zip | 33711-3800
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Country | US
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Telephone | 727-867-2000
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARK D. KRAMER
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Credential |
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Telephone | 813-341-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL10802
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License Number State | FL
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