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General NPI Number Information
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NPI Number | 1801810551
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Entity Type | Organization
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Legal Business Name | 1980 SUNSET POINT ROAD LLC
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 1980 SUNSET POINT RD
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City | CLEARWATER
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State | FL
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Zip | 33765-1132
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Country | US
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Telephone | 727-443-1588
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Fax | 727-442-5916
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Provider Business Mailing Address
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Address Line | 101 E STATE ST COMPLIANCE DEPARTMENT
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City | KENNETT SQUARE
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State | PA
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Zip | 19348-3109
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Country | US
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Telephone | 505-468-4742
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Fax | 505-468-8742
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Authorized Official
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Title or Position | ASSISTANT SECRETARY
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Name | MICHAEL T BERG
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Credential |
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Telephone | 505-468-4742
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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 | SNF 15370961
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License Number State | FL
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