Healthcare Provider Details

I. General information

NPI: 1659926822
Provider Name (Legal Business Name): CIJ VENTURES AND PROPERTIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 S RIDGEWOOD AVE
DAYTONA BEACH FL
32114-5328
US

IV. Provider business mailing address

1616 KENNESAW DR
CLERMONT FL
34711-6871
US

V. Phone/Fax

Practice location:
  • Phone: 386-252-2627
  • Fax:
Mailing address:
  • Phone:
  • 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: JHUELIAN GASMENA
Title or Position: ADMINISTRATOR
Credential:
Phone: 863-899-5363