Provider Demographics
NPI:1689171266
Name:200 VENICE OPERATING LLC
Entity Type:Organization
Organization Name:200 VENICE OPERATING LLC
Other - Org Name:VENICE CENTER FOR INDEPENDENT & ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HILLEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FEUERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-793-0950
Mailing Address - Street 1:200 NASSAU ST N
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-1772
Mailing Address - Country:US
Mailing Address - Phone:941-485-2404
Mailing Address - Fax:
Practice Address - Street 1:200 NASSAU ST N
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-1772
Practice Address - Country:US
Practice Address - Phone:941-485-2404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5534310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility