Provider Demographics
NPI:1598398331
Name:PALM BAY FL OPCO LLC
Entity Type:Organization
Organization Name:PALM BAY FL OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF ADMINISTRATIVE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:BATYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORELICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-723-1235
Mailing Address - Street 1:440 SYLVAN AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1515 PORT MALABAR BLVD NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5437
Practice Address - Country:US
Practice Address - Phone:321-723-1235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No385H00000XRespite Care FacilityRespite Care