MEDICARE: DAYTONA FL OPERATING COMPANY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1184337073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAYTONA FL OPERATING COMPANY LLC

Provider Business Mailing Address
First Line	:	23645 MERCANTILE RD STE J
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5936
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 S SEGRAVE ST
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-4815
Country	:	US
Telephone Number	:	386-239-7520
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOSHUA STURM
Credential	:
Telephone Number	:	347-205-8235

Provider Enumeration Date	:	01/05/2023
Last Update Date	:	10/31/2023

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Directions to “DAYTONA FL OPERATING COMPANY LLC ” Practice Location

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