Provider Demographics
NPI:1629608013
Name:CLERMONT1818 OPCO, LLC
Entity Type:Organization
Organization Name:CLERMONT1818 OPCO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRZYBOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-691-9308
Mailing Address - Street 1:650 E MINNEHAHA AVE
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3445
Mailing Address - Country:US
Mailing Address - Phone:352-241-0844
Mailing Address - Fax:
Practice Address - Street 1:650 E MINNEHAHA AVE
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3445
Practice Address - Country:US
Practice Address - Phone:352-241-0844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility