Provider Demographics
NPI:1740949122
Name:BC SNF, LLC
Entity type:Organization
Organization Name:BC SNF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:ROCKEFELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-422-5231
Mailing Address - Street 1:200 CLEARWATER LARGO RD S
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3235
Mailing Address - Country:US
Mailing Address - Phone:727-581-4607
Mailing Address - Fax:
Practice Address - Street 1:3875 WEDGEWOOD LN
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-9301
Practice Address - Country:US
Practice Address - Phone:352-674-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility