MEDICARE: YBOR CITY SNF OPERATIONS 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427694702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YBOR CITY SNF OPERATIONS LLC

Provider Business Mailing Address
First Line	:	2123 CENTRE POINTE BLVD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4930
Country	:	US
Telephone Number	:	850-386-2831
Fax Number	:	850-386-2016

Provider Business Practice Location Address
First Line	:	1709 N TALIAFERRO AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-2543
Country	:	US
Telephone Number	:	813-223-4623
Fax Number	:	813-223-3718

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. SOLOMON KLEIN
Credential	:
Telephone Number	:	347-909-1811

Provider Enumeration Date	:	11/21/2019
Last Update Date	:	01/17/2020

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