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General NPI Number Information
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NPI Number | 1962115865
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Entity Type | Organization
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Legal Business Name | DELAND FL OPCO, LLC
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Dates
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Enumeration Date | 01/05/2023
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 450 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 | 773-870-7818
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Fax |
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Provider Business Mailing Address
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Address Line | 23645 MERCANTILE RD STE J
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City | BEACHWOOD
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State | OH
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Zip | 44122-5936
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOSHUA STURM
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Credential |
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Telephone | 347-205-8235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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