=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619724937
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE LANDMARK OPERATOR LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2024
-----------------------------------------------------
Last Update Date | 01/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3260 N MCMULLEN BOOTH RD
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33761-2040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-217-6100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 218 E BEARSS AVE SUITE 333
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-447-9260
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MR. ALCIDES SEGUI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-447-9260
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------