Healthcare Provider Details

I. General information

NPI: 1689171266
Provider Name (Legal Business Name): 200 VENICE OPERATING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NASSAU ST N
VENICE FL
34285-1772
US

IV. Provider business mailing address

200 NASSAU ST N
VENICE FL
34285-1772
US

V. Phone/Fax

Practice location:
  • Phone: 941-485-2404
  • Fax:
Mailing address:
  • Phone: 941-485-2404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number5534
License Number StateFL

VIII. Authorized Official

Name: HILLEL FEUERMAN
Title or Position: MANAGER
Credential:
Phone: 718-793-0950