MEDICARE: GULF SHORE NURSING AND REHAB 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	:	1528716032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF SHORE NURSING AND REHAB LLC

Provider Business Mailing Address
First Line	:	6767 86TH AVE N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33782-4597
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6767 86TH AVE N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33782-4597
Country	:	US
Telephone Number	:	727-548-5566
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MOSHE SCHEINER
Credential	:
Telephone Number	:	845-490-6060

Provider Enumeration Date	:	03/14/2022
Last Update Date	:	03/14/2022

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