Provider Demographics
NPI:1942889787
Name:CREF3 FSLP COCONUT CREEK OWNER LLC
Entity Type:Organization
Organization Name:CREF3 FSLP COCONUT CREEK OWNER LLC
Other - Org Name:SONATA COCONUT CREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. REGIONAL DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-938-6414
Mailing Address - Street 1:1 MARKET PLZ FL 42
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-1126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4175 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4456
Practice Address - Country:US
Practice Address - Phone:954-975-6399
Practice Address - Fax:954-975-2367
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREF3 FSLP PORTFOLIO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-07
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility