Basic Information
| Provider Information | |||||||||
| NPI: | 1427694702 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YBOR CITY SNF OPERATIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2123 CENTRE POINTE BLVD | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8503862831 | ||||||||
| FaxNumber: | 8503862016 | ||||||||
| Practice Location | |||||||||
| Address1: | 1709 N TALIAFERRO AVE | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336022543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132234623 | ||||||||
| FaxNumber: | 8132233718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2019 | ||||||||
| LastUpdateDate: | 01/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | KLEIN | ||||||||
| AuthorizedOfficialFirstName: | SOLOMON | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3479091811 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 01/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.