Provider Demographics
NPI:1215191440
Name:EXTENDED CARE PORTFOLIO FLORIDA TENANT, LLC
Entity type:Organization
Organization Name:EXTENDED CARE PORTFOLIO FLORIDA TENANT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF HJ SIMS INVESTMENTS, LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-363-4493
Mailing Address - Street 1:7575 DR PHILLIPS BLVD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4760 JOG RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-5119
Practice Address - Country:US
Practice Address - Phone:561-434-0434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HJ SIMS INVESTMENTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility