Healthcare Provider Details

I. General information

NPI: 1639719081
Provider Name (Legal Business Name): RETIREMENT FIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16605 SE 74TH SOUILIERE AVE
THE VILLAGES FL
32162
US

IV. Provider business mailing address

200 CLEARWATER LARGO RD S
LARGO FL
33770-3228
US

V. Phone/Fax

Practice location:
  • Phone: 352-362-1888
  • Fax: 352-358-5640
Mailing address:
  • Phone: 727-581-4648
  • Fax:

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: KEVIN RYAN ROCKEFELLER
Title or Position: MANAGER
Credential:
Phone: 727-581-4648