MEDICARE: GV DELRAY WEST, 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	311500000X	Alzheimer Center (Dementia Center)
2	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740612555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GV DELRAY WEST, LLC

Provider Business Mailing Address
First Line	:	13770 58TH STREET NORTH
Second Line	:	SUITE 312
City	:	CLEARWATER
State	:	FL
Zip	:	33760
Country	:	US
Telephone Number	:	727-726-3980
Fax Number	:

Provider Business Practice Location Address
First Line	:	5859 HERITAGE PARK WAY
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-8557
Country	:	US
Telephone Number	:	561-499-7744
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	HELEN ALTIERI
Credential	:
Telephone Number	:	727-726-3980

Provider Enumeration Date	:	08/02/2013
Last Update Date	:	08/02/2013

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