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General NPI Number Information
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NPI Number | 1104269141
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Entity Type | Organization
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Legal Business Name | WATERCREST ACQUISITION I LLC
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Dates
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Enumeration Date | 04/09/2013
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Last Update Date | 08/15/2019
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Provider Practice Location Address
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Address Line | 16650 W DIXIE HWY
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33160
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Country | US
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Telephone | 305-945-7447
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Fax |
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Provider Business Mailing Address
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Address Line | 16650 W DIXIE HWY
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33160-3713
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Country | US
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Telephone | 305-945-7447
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Fax | 914-801-2818
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. STEVEN GOTTLIEB
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Credential |
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Telephone | 305-710-6611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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