Healthcare Provider Details

I. General information

NPI: 1538626064
Provider Name (Legal Business Name): GV CLEARWATER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 DREW ST
CLEARWATER FL
33759-3034
US

IV. Provider business mailing address

13770 58TH ST N STE 312
CLEARWATER FL
33760-3759
US

V. Phone/Fax

Practice location:
  • Phone: 727-726-3980
  • Fax:
Mailing address:
  • Phone: 727-726-3980
  • 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: ROBIN MONTHIE
Title or Position: OPERATIONS COORDINATOR
Credential:
Phone: 727-726-3980