Healthcare Provider Details

I. General information

NPI: 1578275103
Provider Name (Legal Business Name): WEST DELRAY OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16200 S JOG RD
DELRAY BEACH FL
33446-2321
US

IV. Provider business mailing address

300 PROVIDER CT
RICHMOND KY
40475-8488
US

V. Phone/Fax

Practice location:
  • Phone: 561-638-0000
  • Fax:
Mailing address:
  • Phone: 917-817-3530
  • 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: MATHEW VARGHESE
Title or Position: AUTHORIZED PERSON
Credential:
Phone: 917-817-3530