MEDICARE: KC PBG HEALTH CENTER, 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	:	1962846709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KC PBG HEALTH CENTER, LLC

Provider Business Mailing Address
First Line	:	5790 FLEET ST
Second Line	:	SUITE 300
City	:	CARLSBAD
State	:	CA
Zip	:	92008-4703
Country	:	US
Telephone Number	:	760-804-5900
Fax Number	:	760-804-5909

Provider Business Practice Location Address
First Line	:	3600 MASTERPIECE WAY
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-2872
Country	:	US
Telephone Number	:	561-514-5000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDREW SCOTT KOHLBERG
Credential	:
Telephone Number	:	760-804-5900

Provider Enumeration Date	:	04/23/2013
Last Update Date	:	04/23/2013

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