Provider Demographics
NPI:1932338076
Name:PINELLAS PARK SNF LLC
Entity Type:Organization
Organization Name:PINELLAS PARK SNF LLC
Other - Org Name:GULF SHORE REHABILITATION AND NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:KARMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-371-1700
Mailing Address - Street 1:368 NEW HEMPSTEAD RD
Mailing Address - Street 2:#309
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6767 86TH AVE
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-4597
Practice Address - Country:US
Practice Address - Phone:727-548-5566
Practice Address - Fax:727-548-6644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026435100Medicaid
FL026435100Medicaid