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NPI Code Detail

MEDICARE: ST PETERSBURG NURSING HOME, LLC

MEDICARE: ST PETERSBURG NURSING HOME, 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 FacilitySNF1252096FL

General Provider Information

NPI Number : 1366433385
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST PETERSBURG NURSING HOME, LLC
Provider Business Mailing Address
First Line : 4250 66TH ST N
Second Line :
City : KENNETH CITY
State : FL
Zip : 33709-4918
Country : US
Telephone Number : 727-546-2405
Fax Number :
Provider Business Practice Location Address
First Line : 4250 66TH ST N
Second Line :
City : KENNETH CITY
State : FL
Zip : 33709-4918
Country : US
Telephone Number : 727-546-2405
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF FINANCE
Name : MICHELLE BURDETTE
Credential :
Telephone Number : 423-308-1845
Provider Enumeration Date : 10/31/2005
Last Update Date : 08/22/2020

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Directions to “ST PETERSBURG NURSING HOME, LLC ” Practice Location

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