Provider Demographics
NPI:1578147567
Name:CREF3 FSLP VERO BEACH OWNER LLC
Entity Type:Organization
Organization Name:CREF3 FSLP VERO BEACH OWNER LLC
Other - Org Name:SONATA VERO 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 1:2425 20TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6615
Mailing Address - Country:US
Mailing Address - Phone:772-770-2401
Mailing Address - Fax:772-770-0313
Practice Address - Street 1:2425 20TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6615
Practice Address - Country:US
Practice Address - Phone:772-770-2401
Practice Address - Fax:772-532-5728
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