Provider Demographics
NPI:1821777848
Name:BRYAN DAIRY ROAD OPCO LLC
Entity Type:Organization
Organization Name:BRYAN DAIRY ROAD OPCO LLC
Other - Org Name:ASPIRE AT BRYAN DAIRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-730-7480
Mailing Address - Street 1:9035 BRYAN DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1104
Mailing Address - Country:US
Mailing Address - Phone:727-395-9619
Mailing Address - Fax:727-392-7203
Practice Address - Street 1:9035 BRYAN DAIRY RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1104
Practice Address - Country:US
Practice Address - Phone:727-395-9619
Practice Address - Fax:727-392-7203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility