Organization
SCG GRACEWOOD LLC
Active
Other names
GraceWood Rehabilitation and Nursing Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN GOYER (PRESIDENT)
(813) 341-2700
Entity
Organization
Contact information
Practice address
8600 US HIGHWAY 19 N, PINELLAS PARK, FL 33782
(727) 541-7515
(727) 545-9473
Mailing address
1240 MARBELLA PLAZA DR, TAMPA, FL 33619-7906
(813) 341-2700
(813) 341-2755
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH4155
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031664400
—
FL
01
—
L85
BLUE CROSS AND BLUE SHIELD
FL
Enumeration date
08/10/2005
Last updated
01/12/2015
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