Basic Information
| Provider Information | |||||||||
| NPI: | 1689171266 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | 200 VENICE OPERATING LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VENICE CENTER FOR INDEPENDENT & ASSISTED LIVING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 NASSAU ST N | ||||||||
| Address2: | |||||||||
| City: | VENICE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342851772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414852404 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 NASSAU ST N | ||||||||
| Address2: | |||||||||
| City: | VENICE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342851772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414852404 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2018 | ||||||||
| LastUpdateDate: | 04/10/2018 | ||||||||
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| AuthorizedOfficialLastName: | FEUERMAN | ||||||||
| AuthorizedOfficialFirstName: | HILLEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7187930950 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 5534 | FL | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.