Provider Demographics
NPI:1619566130
Name:YMP GRAND COURT LAKES OPCO LLC
Entity Type:Organization
Organization Name:YMP GRAND COURT LAKES OPCO LLC
Other - Org Name:GRAND COURT LAKES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-220-8521
Mailing Address - Street 1:4500 N STATE ROAD 7 STE 100
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5868
Mailing Address - Country:US
Mailing Address - Phone:786-220-8521
Mailing Address - Fax:
Practice Address - Street 1:280 SIERRA DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-3897
Practice Address - Country:US
Practice Address - Phone:786-520-3051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility