Healthcare Provider Details

I. General information

NPI: 1598128837
Provider Name (Legal Business Name): GV DELAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E INTERNATIONAL SPEEDWAY BLVD
DELAND FL
32724-2426
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 386-738-5202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number12792
License Number StateFL

VIII. Authorized Official

Name: SCOTT MCINTOSH
Title or Position: REGIONAL MANAGER
Credential:
Phone: 727-726-3980