Basic Information
| Provider Information | |||||||||
| NPI: | 1679172563 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GV PALM COAST, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13770 58TH ST N STE 312 | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337603759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277263980 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 MAGNOLIA TRACE WAY | ||||||||
| Address2: | |||||||||
| City: | PALM COAST | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321642382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3864453500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2020 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | MONTHIE | ||||||||
| AuthorizedOfficialFirstName: | ROBIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR OPERATIONS COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 7277263980 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.