Provider Demographics
NPI:1932536851
Name:NORTH PORT RETIREMENT CENTER, INC.
Entity Type:Organization
Organization Name:NORTH PORT RETIREMENT CENTER, INC.
Other - Org Name:GARDENS OF VENICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZIA
Authorized Official - Middle Name:U
Authorized Official - Last Name:BUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-426-9175
Mailing Address - Street 1:2901 JACARANDA BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-6007
Mailing Address - Country:US
Mailing Address - Phone:941-497-0650
Mailing Address - Fax:941-497-0656
Practice Address - Street 1:2901 JACARANDA BOULEVARD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-6007
Practice Address - Country:US
Practice Address - Phone:941-497-0650
Practice Address - Fax:941-497-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12423310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116462500Medicaid