Provider Demographics
NPI:1467699876
Name:COURTYARD ENTERPRISES OF PORT CHARLOTTE, LLC
Entity Type:Organization
Organization Name:COURTYARD ENTERPRISES OF PORT CHARLOTTE, LLC
Other - Org Name:THE COURTYARD ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:PANSACOLA
Authorized Official - Last Name:SIQUIJOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-979-8119
Mailing Address - Street 1:26455 RAMPART BLVD
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-6211
Mailing Address - Country:US
Mailing Address - Phone:941-624-2225
Mailing Address - Fax:941-625-6125
Practice Address - Street 1:26455 RAMPART BLVD
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983-6211
Practice Address - Country:US
Practice Address - Phone:941-624-2225
Practice Address - Fax:941-625-6125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7326310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility