Basic Information
| Provider Information | |||||||||
| NPI: | 1700239563 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GV DEERFIELD BEACH, LLC | ||||||||
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| OtherOrganizationName: | GRAND VILLA OF DEERFIELD BEACH | ||||||||
| 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: | 1050 SW 24TH AVE | ||||||||
| Address2: | |||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334427601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543607667 | ||||||||
| FaxNumber: | 9543607363 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2016 | ||||||||
| LastUpdateDate: | 07/18/2016 | ||||||||
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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 | 3104A0625X | AL# 8697 | FL | N | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness | 310400000X | AL# 8697 | FL | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.