Healthcare Provider Details

I. General information

NPI: 1174866511
Provider Name (Legal Business Name): GV LAUDERHILL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14555 SIMS RD
DELRAY BEACH FL
33484-8547
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 561-496-1111
  • Fax: 561-637-9990
Mailing address:
  • Phone: 727-726-3980
  • Fax: 727-726-5345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberAL5113
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL5113
License Number StateFL

VIII. Authorized Official

Name: MR. DENNIS FORTE
Title or Position: MANAGER
Credential:
Phone: 727-726-3980