Provider Demographics
NPI:1225026818
Name:SAINT PETERSBURG SNF LLC
Entity Type:Organization
Organization Name:SAINT PETERSBURG SNF LLC
Other - Org Name:BAYSIDE REHABILITATION AND HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTROFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-733-3615
Mailing Address - Street 1:811 JACKSON ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1238
Mailing Address - Country:US
Mailing Address - Phone:727-209-3600
Mailing Address - Fax:727-821-2453
Practice Address - Street 1:811 JACKSON ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1238
Practice Address - Country:US
Practice Address - Phone:727-209-3600
Practice Address - Fax:727-821-2453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-09
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1250095314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL030879000Medicaid
FL030879000Medicaid