1937 Jenks Avenue Operations LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF11870961 Issued in FL

Legal business name

1937 JENKS AVENUE OPERATIONS LLC

Doing business as

Sea Breeze Health Care

Practice address

1937 Jenks Ave
Panama City, FL 32405-4510

Phone

(850) 769-7686

Fax

(850) 769-7680

NPI assigned

Dec 27, 2011

Organization subpart

No

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

Authorized official

Name

Kenneth Ussery

Title

VP

Phone

(407) 571-1550

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Sea Breeze Health Care Doing business as

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

{
    "created_epoch": "1324944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557446400000",
    "number": "1093084733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1937 JENKS AVE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054510",
            "telephone_number": "850-769-7686",
            "fax_number": "850-769-7680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1937 JENKS AVE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054510",
            "telephone_number": "850-769-7686",
            "fax_number": "850-769-7680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1937 JENKS AVENUE OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-27",
        "last_updated": "2019-05-10",
        "status": "A",
        "authorized_official_last_name": "USSERY",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "407-571-1550"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF11870961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005987400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sea Breeze Health Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sea Breeze Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Panama City, FL
• Providers in Panama City, 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 May 10, 2019; 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.