Healthcare Provider Details

I. General information

NPI: 1669154605
Provider Name (Legal Business Name): SANTA BARBARA BLVD OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 SANTA BARBARA BLVD
CAPE CORAL FL
33991-2031
US

IV. Provider business mailing address

216 SANTA BARBARA BLVD
CAPE CORAL FL
33991-2031
US

V. Phone/Fax

Practice location:
  • Phone: 239-772-4600
  • Fax: 239-772-9842
Mailing address:
  • Phone: 239-772-4600
  • Fax: 239-772-9842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: NATHAN FREUND
Title or Position: MANAGER
Credential:
Phone: 732-730-7480