Organization
GULFPORT NURSING CENTER LLC
Active
Other names
Gulfport Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
MATHEW VARGHESE (MEMBER)
(917) 817-3530
Entity
Organization
Contact information
Practice address
1430 PASADENA AVE S, SOUTH PASADENA, FL 33707-3716
(727) 344-8525
(855) 887-9751
Mailing address
1430 PASADENA AVE S, SOUTH PASADENA, FL 33707-3716
(727) 344-8525
(855) 887-9751
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14320962
LICENSE
FL
Enumeration date
07/20/2022
Last updated
07/20/2022
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