Provider Demographics
NPI:1669135570
Name:ELEVATED ESTATES OF NEW PORT RICHEY
Entity type:Organization
Organization Name:ELEVATED ESTATES OF NEW PORT RICHEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YITZCHAK
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-452-2309
Mailing Address - Street 1:7320 ANDORRA PL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-4952
Mailing Address - Country:US
Mailing Address - Phone:347-452-2309
Mailing Address - Fax:
Practice Address - Street 1:7423 KAUAI LOOP
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6102
Practice Address - Country:US
Practice Address - Phone:347-452-2309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELEVATED ESTATES HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility