Organization · NPI-2

2595 Harbor Blvd LLC

Assisted Living Facility · Port Charlotte, FL

NPI number1124775242
StatusActive
Last updated in NPPESNov 15, 2022

Details

NPI
1124775242
Entity type
Organization (NPI-2)
Legal business name
2595 Harbor Blvd LLC
Organization subpart
No
Enumeration date
Mar 8, 2022
Certification date
Nov 15, 2022
Last updated
Nov 15, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
310400000X Assisted Living Facility––Yes

Practice location

2595 Harbor Blvd
Port Charlotte, FL 33952-6732

Phone 941-769-9100

Mailing address

5307 E Mockingbird Ln Ste 575
Dallas, TX 75206-5109

Phone 469-619-5372

Authorized official

Josh Rosen
Manager
4696195372

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