Provider Demographics
NPI:1356540033
Name:SNELL ISLAND SNF LLC
Entity type:Organization
Organization Name:SNELL ISLAND SNF LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:TZVI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGOMILSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-401-7901
Mailing Address - Street 1:1835 NE MIAMI GARDENS DR
Mailing Address - Street 2:#368
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-5035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4500 INDIANAPOLIS ST NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-4317
Practice Address - Country:US
Practice Address - Phone:727-209-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1499095314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032413200Medicaid
FL105050Medicare Oscar/Certification