Provider Demographics
NPI:1376127498
Name:CREF3 FSLP BOYNTON BEACH OWNER LLC
Entity Type:Organization
Organization Name:CREF3 FSLP BOYNTON BEACH OWNER LLC
Other - Org Name:SONATA BOYNTON BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. REGIONAL DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-938-6414
Mailing Address - Street 1:1 MARKET PLZ FL 42
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-1126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-7439
Practice Address - Country:US
Practice Address - Phone:561-733-8444
Practice Address - Fax:561-733-0229
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREF3 FSLP PORTFOLIO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-06
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility