Healthcare Provider Details

I. General information

NPI: 1023790060
Provider Name (Legal Business Name): WEST COLONIAL DRIVE OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15204 W COLONIAL DR
WINTER GARDEN FL
34787-6042
US

IV. Provider business mailing address

15204 W COLONIAL DR
WINTER GARDEN FL
34787-6042
US

V. Phone/Fax

Practice location:
  • Phone: 407-877-2394
  • Fax: 407-877-6143
Mailing address:
  • Phone: 407-877-2394
  • Fax: 407-877-6143

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: NATHAN FREUND
Title or Position: MANAGER
Credential:
Phone: 732-730-7480