Provider Demographics
NPI:1497278519
Name:ST. PETERSBURG OPERATOR LLC
Entity Type:Organization
Organization Name:ST. PETERSBURG OPERATOR LLC
Other - Org Name:BRENTWOOD SENIOR LIVING AT ST. PETE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-427-2669
Mailing Address - Street 1:6300 BLAIR HILL LN FL 4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2042
Mailing Address - Country:US
Mailing Address - Phone:410-427-2669
Mailing Address - Fax:727-289-7096
Practice Address - Street 1:6280 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1429
Practice Address - Country:US
Practice Address - Phone:727-954-7015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility