Provider Demographics
NPI:1780363952
Name:PARK BOULEVARD OPCO LLC
Entity type:Organization
Organization Name:PARK BOULEVARD OPCO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:9393 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-4140
Mailing Address - Country:US
Mailing Address - Phone:727-391-2200
Mailing Address - Fax:727-319-2611
Practice Address - Street 1:9393 PARK BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33777-4140
Practice Address - Country:US
Practice Address - Phone:727-391-2200
Practice Address - Fax:727-319-2611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility