Bayou Shores SNF LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

BAYOU SHORES SNF LLC

Doing business as

Rehabilitation Center of St Pete

Practice address

435 42ND Ave S
Saint Petersburg, FL 33705-4504

Phone

(727) 822-1871

Fax

(727) 894-0836

NPI assigned

Nov 2, 2012

Last updated

Nov 2, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Tzvi Bogomilsky

Title

Authorized Member

Phone

(305) 403-1400

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Rehabilitation Center of St Pete Doing business as

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

{
    "created_epoch": "1351814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351814400000",
    "number": "1063766707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 NE MIAMI GARDENS DR # 368",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "331795035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 42ND AVE S",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337054504",
            "telephone_number": "727-822-1871",
            "fax_number": "727-894-0836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYOU SHORES SNF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-02",
        "last_updated": "2012-11-02",
        "status": "A",
        "authorized_official_last_name": "BOGOMILSKY",
        "authorized_official_first_name": "TZVI",
        "authorized_official_title_or_position": "AUTHORIZED MEMBER",
        "authorized_official_telephone_number": "305-403-1400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000640800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rehabilitation Center of St Pete",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in St Petersburg, FL
• Providers in St Petersburg, 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 Nov 2, 2012; 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.