Organization
BAYOU SHORES SNF LLC
Active
Other names
Rehabilitation Center of St Pete
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TZVI BOGOMILSKY (AUTHORIZED MEMBER)
(305) 403-1400
Entity
Organization
Contact information
Practice address
435 42ND AVE S, SAINT PETERSBURG, FL 33705-4504
(727) 822-1871
(727) 894-0836
Mailing address
1835 NE MIAMI GARDENS DR # 368, NORTH MIAMI BEACH, FL 33179-5035
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000640800
—
FL
Enumeration date
11/02/2012
Last updated
11/02/2012
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