Healthcare Provider Details

I. General information

NPI: 1588427769
Provider Name (Legal Business Name): VENICE PALMS SENIOR LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 JACARANDA BLVD
VENICE FL
34292-4586
US

IV. Provider business mailing address

5801 ULMERTON RD STE 200
CLEARWATER FL
33760-3951
US

V. Phone/Fax

Practice location:
  • Phone: 941-246-7796
  • Fax:
Mailing address:
  • Phone: 727-683-1200
  • 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: TERENCE MCCARTHY
Title or Position: MANAGER
Credential:
Phone: 727-683-1200