Provider Demographics
NPI:1457014417
Name:SEGGYYEN VENTURES LLC
Entity Type:Organization
Organization Name:SEGGYYEN VENTURES LLC
Other - Org Name:OAK ROSE ASSISTED LIVING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLUSEGUN
Authorized Official - Middle Name:
Authorized Official - Last Name:AYENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-909-5904
Mailing Address - Street 1:1810 OAK POND ST
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-7995
Mailing Address - Country:US
Mailing Address - Phone:813-909-5904
Mailing Address - Fax:
Practice Address - Street 1:616 VALLE VISTA DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-7830
Practice Address - Country:US
Practice Address - Phone:813-662-4107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111745300Medicaid