1407879869 NPI number — ASSISTED LIVING AT FROSTBURG VILLAGE FACILITY OPERATIONS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407879869 NPI number — ASSISTED LIVING AT FROSTBURG VILLAGE FACILITY OPERATIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSISTED LIVING AT FROSTBURG VILLAGE FACILITY OPERATIONS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407879869
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 CONCOURSE PKWY S
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MAITLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32751-6148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-571-1550
Provider Business Mailing Address Fax Number:
407-571-1599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 VILLAGE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FROSTBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21532-1452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-689-7480
Provider Business Practice Location Address Fax Number:
301-689-3953
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CONTE
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
407-571-1550

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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