Healthcare Provider Details

I. General information

NPI: 1700395613
Provider Name (Legal Business Name): SENIOR LIVING PROPERTIES IV, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 09/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 N PARSONS AVE
BRANDON FL
33510-3435
US

IV. Provider business mailing address

4611 JOHNSON RD UNIT 1
COCONUT CREEK FL
33073-4361
US

V. Phone/Fax

Practice location:
  • Phone: 813-643-6767
  • Fax: 813-643-4992
Mailing address:
  • Phone: 954-691-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: URI RUBIN
Title or Position: MANAGING PARTNER
Credential:
Phone: 954-691-1030