Provider Demographics
NPI:1649765256
Name:HCP PORT ORANGE FL OPCO, LLC
Entity Type:Organization
Organization Name:HCP PORT ORANGE FL OPCO, LLC
Other - Org Name:ATRIA PORT ORANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP, GENERAL COUNSEL, AND SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:W.
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-779-4700
Mailing Address - Street 1:300 E MARKET ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1968
Mailing Address - Country:US
Mailing Address - Phone:502-779-4700
Mailing Address - Fax:
Practice Address - Street 1:1675 DUNLAWTON AVE
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4755
Practice Address - Country:US
Practice Address - Phone:386-761-1055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9292310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility