Provider Demographics
NPI:1952936742
Name:DAYTONA BEACH FL OPCO LLC
Entity Type:Organization
Organization Name:DAYTONA BEACH FL OPCO LLC
Other - Org Name:BEACH STREET HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF ADMINISTRATIVE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:BATYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORELICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-258-3334
Mailing Address - Street 1:440 SYLVAN AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2700
Mailing Address - Country:US
Mailing Address - Phone:773-633-6795
Mailing Address - Fax:
Practice Address - Street 1:1001 S BEACH ST
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-6204
Practice Address - Country:US
Practice Address - Phone:386-258-3334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No385H00000XRespite Care FacilityRespite Care