Organization
216 SANTA BARBARA BOULEVARD OPERATIONS LLC
Active
Other names
Coral Trace Health Care
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH USSERY (VP)
(407) 571-1550
Entity
Organization
Contact information
Practice address
216 SANTA BARBARA BLVD, CAPE CORAL, FL 33991-2031
(239) 772-4600
(239) 772-9842
Mailing address
216 SANTA BARBARA BLVD, CAPE CORAL, FL 33991-2031
(239) 772-4600
(239) 772-9842
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF11040961
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004384800
—
FL
Enumeration date
12/22/2011
Last updated
11/27/2023
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