Provider Demographics
NPI:1760163547
Name:DELAND FL ALF OPCO LLC
Entity Type:Organization
Organization Name:DELAND FL ALF OPCO LLC
Other - Org Name:BLUE PALMS SENIOR LIVING OF DELAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-290-1489
Mailing Address - Street 1:16690 COLLINS AVE STE 804
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-5685
Mailing Address - Country:US
Mailing Address - Phone:305-298-2665
Mailing Address - Fax:
Practice Address - Street 1:436 N MCDONALD AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-3634
Practice Address - Country:US
Practice Address - Phone:386-736-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility