Organization
2900 TWELFTH STREET NORTH LLC
Active
Parent organization
SUNBRIDGE HEALTHCARE LLC
Other names
Lakeside Pavilion
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUNBRIDGE HEALTHCARE LLC
Authorized official
MICHAEL TENNESSEE BERG (ASSISTANT SECRETARY)
(505) 468-4742
Entity
Organization
Contact information
Practice address
2900 12TH ST N, NAPLES, FL 34103-4528
(239) 261-2554
(239) 261-4540
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(505) 468-4742
(505) 468-8742
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF 12840962
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025684600
—
FL
Enumeration date
07/26/2006
Last updated
01/04/2016
About Stedi
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