Provider Demographics
NPI:1215711650
Name:ELEVATED ESTATES FOREST OAKS LLC
Entity type:Organization
Organization Name:ELEVATED ESTATES FOREST OAKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YITZCHAK
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-452-2309
Mailing Address - Street 1:7320 ANDORRA PL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-4952
Mailing Address - Country:US
Mailing Address - Phone:347-452-2309
Mailing Address - Fax:
Practice Address - Street 1:8055 FOREST OAKS BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-2406
Practice Address - Country:US
Practice Address - Phone:352-683-3323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility