MEDICARE: KISSIMMEE SNF LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1326984873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KISSIMMEE SNF LLC

Provider Business Mailing Address
First Line	:	1500 SOUTHGATE DR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-6593
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 SOUTHGATE DR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-6593
Country	:	US
Telephone Number	:	407-846-7201
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	ROB MANELA
Credential	:
Telephone Number	:	954-774-7412

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	05/13/2026

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Directions to “KISSIMMEE SNF LLC ” Practice Location

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