Provider Demographics
NPI:1487655742
Name:NEWPORT INVESTORS, LLC
Entity Type:Organization
Organization Name:NEWPORT INVESTORS, LLC
Other - Org Name:NEW PORT INN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-386-2831
Mailing Address - Street 1:2123 CENTRE POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4930
Mailing Address - Country:US
Mailing Address - Phone:850-386-2831
Mailing Address - Fax:850-386-2016
Practice Address - Street 1:6120 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-3909
Practice Address - Country:US
Practice Address - Phone:727-848-3617
Practice Address - Fax:727-849-5481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142034800Medicaid
FL686805300Medicaid