Provider Demographics
NPI:1720850035
Name:702 S KINGS AVE OPCO LLC
Entity Type:Organization
Organization Name:702 S KINGS AVE OPCO LLC
Other - Org Name:ASPIRE AT CENTRAL PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-730-7480
Mailing Address - Street 1:702 S KINGS AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5925
Mailing Address - Country:US
Mailing Address - Phone:813-651-1818
Mailing Address - Fax:813-654-4252
Practice Address - Street 1:702 S KINGS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5925
Practice Address - Country:US
Practice Address - Phone:813-651-1818
Practice Address - Fax:813-654-4252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility