Provider Demographics
NPI:1306358536
Name:PINELLAS PARK FACILITY INC
Entity Type:Organization
Organization Name:PINELLAS PARK FACILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-490-6060
Mailing Address - Street 1:400 RELLA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4239
Mailing Address - Country:US
Mailing Address - Phone:845-490-6060
Mailing Address - Fax:
Practice Address - Street 1:8701 49TH ST N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-5331
Practice Address - Country:US
Practice Address - Phone:727-546-4661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility