Healthcare Provider Details

I. General information

NPI: 1790527828
Provider Name (Legal Business Name): BFG GAINESVILLE PROPCO IV, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15951 LOVES MILL LN
GAINESVILLE VA
20155-1587
US

IV. Provider business mailing address

2573 BARRINGTON CIR
TALLAHASSEE FL
32308-6805
US

V. Phone/Fax

Practice location:
  • Phone: 703-952-3755
  • Fax:
Mailing address:
  • Phone: 850-583-7990
  • 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: SETH WALKER
Title or Position: CFO, SRIM
Credential:
Phone: 850-583-7990