195 Mattie M. Kelly Boulevard Operations LLC
NPI 1336418102ActiveOrganization· Skilled Nursing Facility· Destin, FL
Skilled Nursing Facility in Destin, Florida, registered in NPPES in December 2011. The authorized official on file is Kenneth Ussery, Vp.
Overview
| NPI | 1336418102 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Dec 22, 2011 |
| Last updated in NPPES | Nov 27, 2023 |
| Certified by provider | Apr 27, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Skilled Nursing Facility Primary | 314000000X | SNF16210961 | FL |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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