Sa-PG Pinellas, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1418095 Issued in FL

Legal business name

SA-PG PINELLAS, LLC

Practice address

200 16TH Ave SE
Largo, FL 33771-4400

Phone

(727) 585-9377

Fax

(727) 588-9038

NPI assigned

Jun 22, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Bruce Wertheim

Title

Cfo

Phone

(914) 390-4322

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Palm Garden of Pinellas Doing business as

Tax ID family

Palm Garden of Pinellas2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Palm Garden of Pinellas LLC

  • Skilled Nursing Facility
  • Largo, FL
  • NPI 1316372360
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216771200000",
    "number": "1013913235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 16TH AVE SE",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337714400",
            "telephone_number": "727-585-9377",
            "fax_number": "727-588-9038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 16TH AVE SE",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337714400",
            "telephone_number": "727-585-9377",
            "fax_number": "727-588-9038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SA-PG PINELLAS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-22",
        "last_updated": "2008-07-23",
        "status": "A",
        "authorized_official_last_name": "WERTHEIM",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "914-390-4322",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1418095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025750800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palm Garden of Pinellas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shawnna Russell, M.S. CCC-SLP
• Tracy Gayle Rutherford, APRN
• Enver Ruzdija, ARNP-C
• Laurie Ryan, OTR
• Erin Ryczek, OTR/L
• Sa-PG-Largo LLC
• Sacha Saba, M.D.
• Richard P Sable, D.D.S, P.A
• James Joseph Sacca, MD
• Ryan Sacksteder, O.D.

• Skilled Nursing Facility in Largo, FL
• Providers in Largo, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.