MEDICARE: UNIVERSITY CENTER WEST OPERATING 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	314000000X	Skilled Nursing Facility		FL

General Provider Information

NPI Number	:	1730696600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY CENTER WEST OPERATING LLC

Provider Business Mailing Address
First Line	:	1881 79TH STREET CSWY APT 1801
Second Line	:
City	:	NORTH BAY VILLAGE
State	:	FL
Zip	:	33141-4275
Country	:	US
Telephone Number	:	512-810-6250
Fax Number	:

Provider Business Practice Location Address
First Line	:	545 W EUCLID AVE
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-6771
Country	:	US
Telephone Number	:	386-734-9085
Fax Number	:	386-734-7120

Authorized Official
Title or Position	:	MANAGER
Name	:	NANA PELEG
Credential	:
Telephone Number	:	512-810-6250

Provider Enumeration Date	:	01/02/2018
Last Update Date	:	01/02/2018

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