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General NPI Number Information
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NPI Number | 1790265072
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Entity Type | Organization
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Legal Business Name | PRIVCAP MANAGER
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Dates
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Enumeration Date | 08/16/2018
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Last Update Date | 08/16/2018
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Provider Practice Location Address
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Address Line | 408 SW 7TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-2567
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Country | US
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Telephone | 561-952-2501
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Fax | 954-827-0871
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Provider Business Mailing Address
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Address Line | 7200 CAMINO REAL STE 200
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City | BOCA RATON
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State | FL
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Zip | 33433-5511
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Country | US
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Telephone | 561-952-2501
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Fax | 954-827-0871
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Authorized Official
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Title or Position | OPERATIONS
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Name | THERESA SANTANA
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Credential |
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Telephone | 954-609-7614
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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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