Basic Information
| Provider Information | |||||||||
| NPI: | 1639510084 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WG, JUPITER, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ATRIA AT ST. JOSEPH'S | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S 4TH ST STE 1900 | ||||||||
| Address2: | ATTN: LEGAL DEPT. | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402024436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5027794700 | ||||||||
| FaxNumber: | 5027794749 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 BUSH RD | ||||||||
| Address2: | |||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334585694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617471135 | ||||||||
| FaxNumber: | 5613544051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2013 | ||||||||
| LastUpdateDate: | 07/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | HUDSON | ||||||||
| AuthorizedOfficialFirstName: | W. | ||||||||
| AuthorizedOfficialMiddleName: | BRYAN | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED REPRESENTATIVE | ||||||||
| AuthorizedOfficialTelephone: | 5027794700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | APPLIED FOR | FL | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.