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General NPI Number Information
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NPI Number | 1184428435
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Entity Type | Organization
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Legal Business Name | GV PORT CHARLOTTE, LLC
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 2500 AARON ST
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6743
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Country | US
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Telephone | 941-627-6762
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Fax |
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Provider Business Mailing Address
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Address Line | 13770 58TH ST N STE 312
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City | CLEARWATER
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State | FL
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Zip | 33760-3759
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Country | US
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Telephone | 727-726-3980
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | ROBIN MONTHIE
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Credential |
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Telephone | 727-726-3980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number |
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License Number State |
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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 |
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License Number State |
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