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General NPI Number Information
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NPI Number | 1184062259
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Entity Type | Organization
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Legal Business Name | EXTENDED CARE PORTFOLIO FLORIDA TENANT, LLC
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Dates
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Enumeration Date | 06/11/2013
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 4760 S JOG RD
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City | GREENACRES
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State | FL
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Zip | 33467-5119
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Country | US
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Telephone | 561-434-0434
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Fax |
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Provider Business Mailing Address
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Address Line | 1775 HANCOCK ST STE 200
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City | SAN DIEGO
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State | CA
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Zip | 92110-2036
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Country | US
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Telephone | 619-296-9000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEEPAK ISRANI
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Credential |
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Telephone | 619-296-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL9409
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL99
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL9666
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License Number State | FL
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