Basic Information
| Provider Information | |||||||||
| NPI: | 1861993206 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EC OPCO CARROLLWOOD, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5885 MEADOWS RD STE 500 | ||||||||
| Address2: | |||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970358646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712134234 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2626 W BEARSS AVE | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336181933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9045199300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2018 | ||||||||
| LastUpdateDate: | 03/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | FLEMING | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 9713733922 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.