Provider Demographics
NPI:1164064390
Name:ESTAPONA OPERATING, LLC
Entity Type:Organization
Organization Name:ESTAPONA OPERATING, LLC
Other - Org Name:STRIVE AT FERN PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-740-8815
Mailing Address - Street 1:496 S HUNT CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4948
Mailing Address - Country:US
Mailing Address - Phone:407-740-8815
Mailing Address - Fax:
Practice Address - Street 1:7255 STRIVE PLACE
Practice Address - Street 2:
Practice Address - City:FERN PARK
Practice Address - State:FL
Practice Address - Zip Code:32730
Practice Address - Country:US
Practice Address - Phone:407-848-1743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility