Provider Demographics
NPI:1760519052
Name:SCG PALAZZO OPERATOR, LLC
Entity Type:Organization
Organization Name:SCG PALAZZO OPERATOR, LLC
Other - Org Name:PALAZZO DI ORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-255-1810
Mailing Address - Street 1:16 NORCROSS ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3864
Mailing Address - Country:US
Mailing Address - Phone:770-255-1810
Mailing Address - Fax:770-255-0059
Practice Address - Street 1:3600 34TH ST SOUTH
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:33711
Practice Address - Country:US
Practice Address - Phone:727-867-2000
Practice Address - Fax:727-867-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility