Provider Demographics
NPI: | 1053820209 |
---|---|
Name: | GAHC4 BRADENTON FL TRS SUB, LLC |
Entity Type: | Organization |
Organization Name: | GAHC4 BRADENTON FL TRS SUB, LLC |
Other - Org Name: | BRADENTON OAKS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DANNY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PROSKY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 949-270-9200 |
Mailing Address - Street 1: | 18191 VON KARMAN AVE STE 300 |
Mailing Address - Street 2: | |
Mailing Address - City: | IRVINE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92612-7106 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 949-270-9200 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1015 7TH AVE E |
Practice Address - Street 2: | |
Practice Address - City: | BRADENTON |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34208-2103 |
Practice Address - Country: | US |
Practice Address - Phone: | 941-417-0401 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-09-20 |
Last Update Date: | 2017-09-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | 310400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility |