Organization
J2112, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN RYAN ROCKEFELLER (MANAGER)
(904) 422-5231
Entity
Organization
Contact information
Practice address
11300 110TH AVE, SEMINOLE, FL 33778-3711
(727) 391-9986
Mailing address
200 CLEARWATER LARGO RD S, LARGO, FL 33770-3235
(727) 489-0857
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
10/05/2022
Last updated
10/05/2022
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