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NPI Code Detail

MEDICARE: TOMOKA RIVER HOLDINGS LLC

MEDICARE: TOMOKA RIVER HOLDINGS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1134045750
Entity Type Code : Organization
Provider Name (Legal Business Name) : TOMOKA RIVER HOLDINGS LLC
Provider Business Mailing Address
First Line : 16544 FRANZEN FARM RD
Second Line :
City : SAN DIEGO
State : CA
Zip : 92127-2240
Country : US
Telephone Number : 858-798-5700
Fax Number :
Provider Business Practice Location Address
First Line : 4445 PINE FOREST DR
Second Line :
City : GREENACRES
State : FL
Zip : 33463-4676
Country : US
Telephone Number : 858-798-5700
Fax Number :
Authorized Official
Title or Position : CFO
Name : MR. JEFFREY DANA
Credential :
Telephone Number : 856-430-3198
Provider Enumeration Date : 06/26/2026
Last Update Date : 06/26/2026

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Directions to “TOMOKA RIVER HOLDINGS LLC ” Practice Location

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