Healthcare Provider Details

I. General information

NPI: 1518792076
Provider Name (Legal Business Name): CPIF CORAL LANDING OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 OLD MOULTRIE RD
ST AUGUSTINE FL
32086-5454
US

IV. Provider business mailing address

1910 FAIRVIEW AVE E STE 200
SEATTLE WA
98102-3698
US

V. Phone/Fax

Practice location:
  • Phone: 904-794-2273
  • 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 State

VIII. Authorized Official

Name: ALAN SPRAGINS
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 206-728-9063