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General NPI Number Information
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NPI Number | 1841532025
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Entity Type | Organization
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Legal Business Name | ORIGIN HOSPITALITY LLC
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 2910 OLD CANOE CREEK RD
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City | SAINT CLOUD
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State | FL
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Zip | 34772
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Country | US
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Telephone | 407-593-1524
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Fax | 407-593-1525
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Provider Business Mailing Address
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Address Line | 17503 LA CANTERA PKWY #104618
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City | SAN ANTONIO
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State | TX
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Zip | 78257
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Country | US
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Telephone | 832-385-2295
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Fax | 855-557-2835
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. MITESH PATEL
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Credential |
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Telephone | 832-385-2295
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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 | AL11478
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License Number State | FL
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