Provider Demographics
NPI:1174349625
Name:NYSPYER2 SKILLED NURSING SERVICE LLC
Entity type:Organization
Organization Name:NYSPYER2 SKILLED NURSING SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PRACTICAL NURSE
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:FORT
Authorized Official - Suffix:
Authorized Official - Credentials:PN997881
Authorized Official - Phone:352-246-5355
Mailing Address - Street 1:5805 NW 27TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-1942
Mailing Address - Country:US
Mailing Address - Phone:352-246-5355
Mailing Address - Fax:
Practice Address - Street 1:5805 NW 27TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-1942
Practice Address - Country:US
Practice Address - Phone:352-246-5355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty