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General NPI Number Information
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NPI Number | 1598128837
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Entity Type | Organization
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Legal Business Name | GV DELAND, LLC
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 04/04/2016
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Provider Practice Location Address
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Address Line | 350 E INTERNATIONAL SPEEDWAY BLVD
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City | DELAND
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State | FL
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Zip | 32724-2426
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Country | US
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Telephone | 386-738-5202
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Fax |
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Provider Business Mailing Address
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Address Line | 13770 58TH ST N SUITE 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 |
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Fax |
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Authorized Official
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Title or Position | REGIONAL MANAGER
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Name | SCOTT MCINTOSH
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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 | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 12792
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License Number State | FL
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