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General NPI Number Information
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NPI Number | 1619566130
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Entity Type | Organization
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Legal Business Name | YMP GRAND COURT LAKES OPCO LLC
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Dates
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Enumeration Date | 01/11/2021
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Last Update Date | 01/20/2021
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Provider Practice Location Address
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Address Line | 280 SIERRA DR
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City | MIAMI
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State | FL
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Zip | 33179-3897
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Country | US
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Telephone | 786-520-3051
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 N STATE ROAD 7 STE 100
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33319-5868
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Country | US
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Telephone | 786-220-8521
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SAMUEL POTTER
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Credential |
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Telephone | 786-220-8521
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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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