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General NPI Number Information
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NPI Number | 1760163547
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Entity Type | Organization
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Legal Business Name | DELAND FL ALF OPCO LLC
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Dates
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Enumeration Date | 07/26/2023
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Last Update Date | 04/18/2024
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Provider Practice Location Address
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Address Line | 436 N MCDONALD AVE
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City | DELAND
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State | FL
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Zip | 32724-3634
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Country | US
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Telephone | 386-736-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 16690 COLLINS AVE STE 804
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City | SUNNY ISLES BEACH
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State | FL
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Zip | 33160-5685
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Country | US
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Telephone | 305-298-2665
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MR. BEN FRIED
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Credential |
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Telephone | 646-290-1489
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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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