Healthcare Provider Details

I. General information

NPI: 1205311305
Provider Name (Legal Business Name): TERRACINA III, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6869 DAVIS BOULEVARD
NAPLES FL
34104
US

IV. Provider business mailing address

1107 HAZELTINE BLVD STE 200
CHASKA MN
55318-1070
US

V. Phone/Fax

Practice location:
  • Phone: 952-361-8000
  • Fax: 952-361-8060
Mailing address:
  • Phone: 952-361-8000
  • Fax: 952-361-8060

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: JAMES A WEICHERT
Title or Position: AUTHORIZED OFFICIAL
Credential: CPA
Phone: 952-361-8000