Basic Information
| Provider Information | |||||||||
| NPI: | 1033664545 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GV NEW PORT RICHEY, LLC | ||||||||
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| OtherOrganizationName: | GRAND VILLA OF NEW PORT RICHEY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13770 58TH ST N | ||||||||
| Address2: | SUITE 312 | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337603759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277263980 | ||||||||
| FaxNumber: | 7277265345 | ||||||||
| Practice Location | |||||||||
| Address1: | 6120 CONGRESS ST | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346533909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278483617 | ||||||||
| FaxNumber: | 7278469288 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2016 | ||||||||
| LastUpdateDate: | 08/25/2016 | ||||||||
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| AuthorizedOfficialLastName: | SIZEMORE | ||||||||
| AuthorizedOfficialFirstName: | JOHNNY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OPERATIONS COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 7277263980 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | AL# 4832 | FL | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.