MEDICARE: BRYNWOOD 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	:	1720690027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRYNWOOD 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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1656 S JEFFERSON ST
Second Line	:
City	:	MONTICELLO
State	:	FL
Zip	:	32344-1652
Country	:	US
Telephone Number	:	850-997-1800
Fax Number	:

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

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	08/18/2020

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Directions to “BRYNWOOD OPERATIONS LLC ” Practice Location

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