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General NPI Number Information
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NPI Number | 1952936742
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Entity Type | Organization
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Legal Business Name | DAYTONA BEACH FL OPCO LLC
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Dates
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Enumeration Date | 03/11/2020
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Last Update Date | 11/23/2022
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Provider Practice Location Address
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Address Line | 1001 S BEACH ST
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-6204
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Country | US
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Telephone | 386-258-3334
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Fax |
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Provider Business Mailing Address
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Address Line | 440 SYLVAN AVE STE 240
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-2700
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Country | US
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Telephone | 773-633-6795
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Fax |
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Authorized Official
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Title or Position | VP OF ADMINISTRATIVE SERVICES
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Name | BATYA GORELICK
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Credential |
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Telephone | 386-258-3334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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