Provider Demographics
NPI:1346876893
Name:CABOT COVE WEST, LLC
Entity Type:Organization
Organization Name:CABOT COVE WEST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ELDON
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-326-9005
Mailing Address - Street 1:3315 FOXRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2150
Mailing Address - Country:US
Mailing Address - Phone:813-326-9005
Mailing Address - Fax:866-842-2660
Practice Address - Street 1:333 16TH AVE SE
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-4407
Practice Address - Country:US
Practice Address - Phone:813-326-9005
Practice Address - Fax:866-842-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility