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NPI Code Detail

MEDICARE: 18TH ST SARASOTA, OPCO LLC

MEDICARE: 18TH ST SARASOTA, OPCO 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1366228132
Entity Type Code : Organization
Provider Name (Legal Business Name) : 18TH ST SARASOTA, OPCO LLC
Provider Business Mailing Address
First Line : 144 SHADY LANE DR
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-2351
Country : US
Telephone Number : 732-364-2444
Fax Number :
Provider Business Practice Location Address
First Line : 1755 18TH ST
Second Line :
City : SARASOTA
State : FL
Zip : 34234-8657
Country : US
Telephone Number : 718-916-1443
Fax Number :
Authorized Official
Title or Position : AUTHORIZED MEMBER
Name : JOE NEUMAN
Credential :
Telephone Number : 718-916-1443
Provider Enumeration Date : 09/06/2023
Last Update Date : 09/06/2023

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Directions to “18TH ST SARASOTA, OPCO LLC ” Practice Location

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