Provider Demographics
NPI:1316377351
Name:FKP SUN CITY SENIOR LIVING TENANT LLC
Entity Type:Organization
Organization Name:FKP SUN CITY SENIOR LIVING TENANT LLC
Other - Org Name:BELVEDERE COMMONS OF SUN CITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:S.V.P. MANAGING AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOEDIGHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-971-9273
Mailing Address - Street 1:758 CORTARO DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6803
Mailing Address - Country:US
Mailing Address - Phone:813-642-8400
Mailing Address - Fax:813-642-0306
Practice Address - Street 1:758 CORTARO DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6803
Practice Address - Country:US
Practice Address - Phone:813-642-8400
Practice Address - Fax:813-642-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9323310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility