Organization
EAST BAY NC, LLC
Active
Other names
East Bay Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAMUEL B KELLETT (AS SOLE MEMBER OF SBK CAPITAL LLC)
(404) 233-7048
Entity
Organization
Contact information
Practice address
4470 E BAY DR, CLEARWATER, FL 33764-5772
(727) 530-7100
(727) 539-8024
Mailing address
4470 E BAY DR, CLEARWATER, FL 33764-5772
(727) 530-7100
(727) 539-8024
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF11340962
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026453900
—
FL
01
—
V516P-6822
VA
—
Enumeration date
09/29/2005
Last updated
01/30/2009
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