Provider Demographics
NPI:1720721020
Name:BRANDON OPCO LLC, DBA THE MERIDIAN AT BRANDON
Entity Type:Organization
Organization Name:BRANDON OPCO LLC, DBA THE MERIDIAN AT BRANDON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTLEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-896-0740
Mailing Address - Street 1:9215 CAUSEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-6608
Mailing Address - Country:US
Mailing Address - Phone:813-896-0740
Mailing Address - Fax:813-609-0010
Practice Address - Street 1:9215 CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-6608
Practice Address - Country:US
Practice Address - Phone:813-896-0740
Practice Address - Fax:813-609-0010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERIDIAN SENIOR LIVING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility