Provider Demographics
NPI:1619394368
Name:CABOT COVE ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:CABOT COVE ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:VINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-501-9863
Mailing Address - Street 1:455 BELCHER RD S
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-5522
Mailing Address - Country:US
Mailing Address - Phone:727-539-1200
Mailing Address - Fax:727-286-2985
Practice Address - Street 1:455 BELCHER RD S
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-5522
Practice Address - Country:US
Practice Address - Phone:727-539-1200
Practice Address - Fax:727-286-2985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10249310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11215500Medicaid