Healthcare Provider Details

I. General information

NPI: 1700226883
Provider Name (Legal Business Name): GV PINELLAS PARK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8980 49TH STREET NORTH
PINELLAS PARK FL
33782
US

IV. Provider business mailing address

13770 58TH STREET NORTH SUITE 312
CLEARWATER FL
33760
US

V. Phone/Fax

Practice location:
  • Phone: 727-546-4053
  • Fax:
Mailing address:
  • Phone: 727-726-3980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number5487
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number5489
License Number StateFL

VIII. Authorized Official

Name: MRS. NIKI PLUMMER
Title or Position: MANAGER
Credential:
Phone: 727-726-3980