MEDICARE: GV DEERFIELD BEACH, 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	3104A0625X	Assisted Living Facility (Mental Illness)	AL# 8697	FL
2	310400000X	Assisted Living Facility	AL# 8697	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700239563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GV DEERFIELD BEACH, LLC

Provider Business Mailing Address
First Line	:	13770 58TH ST N
Second Line	:	SUITE 312
City	:	CLEARWATER
State	:	FL
Zip	:	33760-3759
Country	:	US
Telephone Number	:	727-726-3980
Fax Number	:	727-726-5345

Provider Business Practice Location Address
First Line	:	1050 SW 24TH AVE
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-7601
Country	:	US
Telephone Number	:	954-360-7667
Fax Number	:	954-360-7363

Authorized Official
Title or Position	:	OPERATIONS COORDINATOR
Name	:	JOHNNY SIZEMORE
Credential	:
Telephone Number	:	727-726-3980

Provider Enumeration Date	:	07/18/2016
Last Update Date	:	07/18/2016

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Directions to “GV DEERFIELD BEACH, LLC ” Practice Location

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