Healthcare Provider Details

I. General information

NPI: 1407768419
Provider Name (Legal Business Name): WEST MELBOURNE I AL OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 GREENBORO DR
WEST MELBOURNE FL
32904-1424
US

IV. Provider business mailing address

600 3RD AVE FL 21
NEW YORK NY
10016-1916
US

V. Phone/Fax

Practice location:
  • Phone: 321-374-6149
  • Fax:
Mailing address:
  • Phone: 332-322-1990
  • 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: ALIDA CATHLEEN RAYNOR
Title or Position: CLINICAL COMPLIANCE NURSE
Credential: RN
Phone: 206-501-6732