Healthcare Provider Details

I. General information

NPI: 1184337073
Provider Name (Legal Business Name): DAYTONA FL OPERATING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 10/31/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 S SEGRAVE ST
DAYTONA BEACH FL
32114-4815
US

IV. Provider business mailing address

23645 MERCANTILE RD STE J
BEACHWOOD OH
44122-5936
US

V. Phone/Fax

Practice location:
  • Phone: 386-239-7520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: JOSHUA STURM
Title or Position: CEO
Credential:
Phone: 347-205-8235