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NPI Code Detail

MEDICARE: BRISTOL SNF LLC

MEDICARE: BRISTOL SNF 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

Other Identifiers

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

General Provider Information

NPI Number : 1750967337
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRISTOL SNF LLC
Provider Business Mailing Address
First Line : 400 RELLA BLVD STE 200
Second Line :
City : MONTEBELLO
State : NY
Zip : 10901-4239
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1818 E FLETCHER AVE
Second Line :
City : TAMPA
State : FL
Zip : 33612-3770
Country : US
Telephone Number : 813-971-2383
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : MICHAEL BLEICH
Credential :
Telephone Number : 845-641-8314
Provider Enumeration Date : 03/23/2021
Last Update Date : 03/23/2021

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Directions to “BRISTOL SNF LLC ” Practice Location

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