Healthcare Provider Details

I. General information

NPI: 1457738908
Provider Name (Legal Business Name): HOBE SOUND OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 SE FEDERAL HWY
HOBE SOUND FL
33455-2009
US

IV. Provider business mailing address

480 FENTRESS BLVD SUITE H
DAYTONA BEACH FL
32114-1238
US

V. Phone/Fax

Practice location:
  • Phone: 386-255-1054
  • 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 StateFL

VIII. Authorized Official

Name: CAMERON MARSH
Title or Position: CORPORATE FINANCE
Credential:
Phone: 386-255-1054