Provider Demographics
NPI:1649813957
Name:GV NAPLES OPCO, LLC
Entity type:Organization
Organization Name:GV NAPLES OPCO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGERIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DELAURENZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-556-5885
Mailing Address - Street 1:101 CYPRESS WAY E
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1244
Mailing Address - Country:US
Mailing Address - Phone:239-514-0300
Mailing Address - Fax:239-514-0547
Practice Address - Street 1:101 CYPRESS WAY E
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1244
Practice Address - Country:US
Practice Address - Phone:786-556-5885
Practice Address - Fax:239-514-0547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103383100Medicaid