Eagle Lake Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

EAGLE LAKE OPCO LLC

Practice address

1100 66TH St N
St Petersburg, FL 33710-6224

Phone

(914) 548-7617

NPI assigned

Jun 3, 2025

Organization subpart

No

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

Authorized official

Name

Steven Bicky

Title

Manager

Phone

(914) 548-7617

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1748908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748908800000",
    "number": "1659265965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 66TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337106224",
            "telephone_number": "914-548-7617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 66TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337106224",
            "telephone_number": "914-548-7617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE LAKE OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-03",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A",
        "authorized_official_last_name": "BICKY",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "914-548-7617"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joy Dziopala, ARNP
• E & S Family Medicine Physicians
• E Therapy Staffing Solutions
• Eagle Lake Foundation Inc
• Eagle Lake Nursing & Rehab Opco LLC
• Eagle Lake Rehab & Nursing LLC
• Eagle Lake Rehab & Nursing, LLC
• Jane Eagle
• Joanne Eames, APRN
• Ashley Maria Eardley

• 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 Jun 3, 2025; 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.