MEDICARE: NSS-ALF ST PETERSBURG

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1891330528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NSS-ALF ST PETERSBURG

Provider Business Mailing Address
First Line	:	48 PAVILION AVE STE 2
Second Line	:
City	:	LONG BRANCH
State	:	NJ
Zip	:	07740-6413
Country	:	US
Telephone Number	:	732-403-3151
Fax Number	:

Provider Business Practice Location Address
First Line	:	3479 54TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33714-2426
Country	:	US
Telephone Number	:	732-403-3151
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DREW BARILE
Credential	:
Telephone Number	:	732-403-3151

Provider Enumeration Date	:	11/18/2019
Last Update Date	:	11/18/2019

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Directions to “NSS-ALF ST PETERSBURG ” Practice Location

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