Provider Demographics
NPI:1083884571
Name:EXTENDED CARE PORTFOLIO MULTISTATE POOL TENANT, LLC
Entity Type:Organization
Organization Name:EXTENDED CARE PORTFOLIO MULTISTATE POOL TENANT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, HJ SIMS INVESTMENTS
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 1:9045 W ATHENS ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-8155
Practice Address - Country:US
Practice Address - Phone:623-876-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HJ SIMS INVESTMENTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility