Ccrc Opco - Freedom Square, LLC
Skilled Nursing Facility in Seminole, FL. Organization (NPI-2).
NPI number1104875152
StatusActive
Last updated in NPPESOct 3, 2014
Details
- NPI
- 1104875152
- Entity type
- Organization (NPI-2)
- Legal business name
- Ccrc Opco - Freedom Square, LLC
- Organization subpart
- Yes
- Enumeration date
- May 8, 2006
- Last updated
- Oct 3, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 314000000X | Skilled Nursing Facility | SNF14960961 | FL | Yes |
Other names
- Seminole Pavilion Rehabilitation & Nursing Services (Doing Business As)
Practice location
10800 Temple TerraceSeminole, FL 33772-4736
Phone 727-398-0166 · Fax 727-398-0188
Mailing address
10800 Temple TerraceSeminole, FL 33772-4736
Phone 727-398-0166 · Fax 727-398-0188
Authorized official
Mark W Ohlendorf
President
4149185000
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All 9 Skilled Nursing Facility providers in Seminole · All 962 providers in Seminole
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