Provider Demographics
NPI:1194726638
Name:BOCA CIEGA INVESTORS LLC
Entity type:Organization
Organization Name:BOCA CIEGA INVESTORS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-386-2522
Mailing Address - Street 1:2123 CENTRE POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4930
Mailing Address - Country:US
Mailing Address - Phone:850-386-2831
Mailing Address - Fax:850-386-2016
Practice Address - Street 1:1255 PASADENA AVE S
Practice Address - Street 2:SUITE C
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-6200
Practice Address - Country:US
Practice Address - Phone:727-828-3500
Practice Address - Fax:727-343-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026772400Medicaid
5539940001Medicare NSC
FL105537Medicare ID - Type Unspecified