1061 Virginia Street Operations LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF15100962 Issued in FL

Legal business name

1061 VIRGINIA STREET OPERATIONS LLC

Practice address

1061 Virginia St
Dunedin, FL 34698-7326

Phone

(727) 733-4189

Fax

(727) 734-7651

NPI assigned

Dec 22, 2011

Organization subpart

No

Name

Kenneth Ussery

Title

VP

Phone

(407) 571-1550

• Lakeside Oaks Care Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 27, 2023.

{
    "created_epoch": "1324512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1174892947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1061 VIRGINIA ST",
            "city": "DUNEDIN",
            "state": "FL",
            "postal_code": "346987326",
            "telephone_number": "727-733-4189",
            "fax_number": "727-734-7651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1061 VIRGINIA ST",
            "city": "DUNEDIN",
            "state": "FL",
            "postal_code": "346987326",
            "telephone_number": "727-733-4189",
            "fax_number": "727-734-7651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1061 VIRGINIA STREET OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-22",
        "last_updated": "2023-11-27",
        "certification_date": "2020-05-07",
        "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": "SNF15100962",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006114000",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://65.196.137.118:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "urn:oid:2.16.840.1.113883.3.5042",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "800 Concourse Pkwy S Ste 200",
            "city": "Maitland",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327516148",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Lakeside Oaks Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lakeside Oaks Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 1059 Virginia St Opco LLC
• 1061 Virginia St Opco LLC
• 1330 LLC
• 1351 Golden LLC
• 1351 Management LLC
• Aaditt LLC
• Marianne Abadir

• All providers in Dunedin, FL
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.