Basic Information
| Provider Information | |||||||||
| NPI: | 1891444865 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PINELLAS PARK FL OPCO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23645 MERCANTILE RD STE J | ||||||||
| Address2: | |||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441225936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466490478 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8701 49TH ST N | ||||||||
| Address2: | |||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337825331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466491131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2022 | ||||||||
| LastUpdateDate: | 03/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | KASPER | ||||||||
| AuthorizedOfficialFirstName: | AARON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OF STAFF | ||||||||
| AuthorizedOfficialTelephone: | 6466491131 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.