Healthcare Provider Details

I. General information

NPI: 1184665077
Provider Name (Legal Business Name): TERRACINA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6825 DAVIS BLVD
NAPLES FL
34104-5322
US

IV. Provider business mailing address

1107 HAZELTINE BLVD SUITE 200
CHASKA MN
55318-1009
US

V. Phone/Fax

Practice location:
  • Phone: 239-455-1459
  • Fax: 239-455-7359
Mailing address:
  • Phone: 952-361-8000
  • Fax: 952-361-8058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL10071
License Number StateFL

VIII. Authorized Official

Name: MR. JOHN B GOODMAN
Title or Position: PRESIDENT OF MANAGING MEMBER
Credential:
Phone: 952-361-8000