MEDICARE: CREF3 FSLP BOCA RATON OWNER 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
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1427632546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREF3 FSLP BOCA RATON OWNER LLC

Provider Business Mailing Address
First Line	:	1 MARKET PLZ FL 42
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94105-1126
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9591 YAMATO RD
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33434-5549
Country	:	US
Telephone Number	:	561-477-8808
Fax Number	:	561-477-1665

Authorized Official
Title or Position	:	SR. REGIONAL DIRECTOR OF OPERATIONS
Name	:	BRYCE WILLIAM ROBINSON
Credential	:
Telephone Number	:	239-938-6414

Provider Enumeration Date	:	05/06/2021
Last Update Date	:	03/11/2022

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