1530 Broad Avenue Operations, LLC
NPI #1306593900 in Gulfport, Mississippi
Provider Information
- NPI Number
- 1306593900
- Entity Type
- Organization
- Organization Name
- 1530 Broad Avenue Operations, LLC
- Primary Specialty
- Skilled Nursing Facility
- Enumeration Date
- Mar 4, 2022
- Last Updated
- Sep 13, 2024
Practice Location
- Address
- 1530 BROAD AVE
- City
- Gulfport
- State
- Mississippi
- ZIP Code
- 39501-3601
- Phone
- (253) 278-2258
Authorized Official
- Name
- TIM LEHNER
- Title
- MANAGER
- Phone
- (770) 698-9040
Specialties & Taxonomy Codes
| Specialty |
|---|
| Skilled Nursing Facility |
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