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General NPI Number Information
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NPI Number | 1568764991
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Entity Type | Organization
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Legal Business Name | BLC TAVARES-GC,LLC
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Dates
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Enumeration Date | 11/17/2010
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 1211 E CAROLINE ST
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City | TAVARES
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State | FL
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Zip | 32778-3460
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Country | US
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Telephone | 353-343-6464
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Fax | 352-343-2909
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Provider Business Mailing Address
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Address Line | 111 WESTWOOD PL SUITE 400
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City | BRENTWOOD
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State | TN
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Zip | 37027-5021
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-PRESIDENT
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Name | MARK OHLENDORF
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Credential |
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Telephone | 414-918-5000
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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 |
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License Number State |
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