Healthcare Provider Details

I. General information

NPI: 1407198500
Provider Name (Legal Business Name): SENIOR LIVING PROPERTIES IV, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 ALEXANDRIA BLVD
OVIEDO FL
32765-5516
US

IV. Provider business mailing address

4611 JOHNSON RD SUITE 1
COCONUT CREEK FL
33073-4361
US

V. Phone/Fax

Practice location:
  • Phone: 407-977-8786
  • Fax: 407-977-1033
Mailing address:
  • Phone: 954-691-1030
  • Fax: 954-691-1036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberAL9307
License Number StateFL

VIII. Authorized Official

Name: MR. URI RUBIN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 954-691-1030