Provider Demographics
NPI:1326668120
Name:KEY WEST NURSING HOME PROPCO LLC
Entity Type:Organization
Organization Name:KEY WEST NURSING HOME PROPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BICKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-548-7617
Mailing Address - Street 1:2745 NE 184TH WAY
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160
Mailing Address - Country:US
Mailing Address - Phone:914-548-7617
Mailing Address - Fax:
Practice Address - Street 1:5860 COLLEGE ROAD
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040
Practice Address - Country:US
Practice Address - Phone:914-548-7617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RED STONE MANOR INVESTMENTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility