Provider Demographics
NPI:1184665077
Name:TERRACINA, LLC
Entity type:Organization
Organization Name:TERRACINA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-361-8000
Mailing Address - Street 1:1107 HAZELTINE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1009
Mailing Address - Country:US
Mailing Address - Phone:952-361-8000
Mailing Address - Fax:952-361-8058
Practice Address - Street 1:6825 DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-5322
Practice Address - Country:US
Practice Address - Phone:239-455-1459
Practice Address - Fax:239-455-7359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10071310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility