Organization · Type 2 NPI

CCRC Opco - Freedom Square, LLC

Skilled Nursing Facility · Seminole, FL

NPI number 1104875152 Active

Practice location

10800 Temple Terrace
Seminole, FL 33772-4736

Fax (727) 398-0188

Specialties and licenses

Taxonomy	Code	License
Skilled Nursing Facility Primary	314000000X	SNF14960961 (FL)

Skilled Nursing Facility: (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to r…

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NPI record

NPI: 1104875152
Entity type: Organization (Type 2)
Issued: May 8, 2006
Last updated: Oct 3, 2014
Status: Active
Subpart: Yes of Brookdale Senior Living Inc

Other names

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Seminole Pavilion Rehabilitation & Nursing Services · doing business as

Authorized official

Mr. Mark W Ohlendorf
President
(414) 918-5000

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1104875152

CCRC Opco - Freedom Square, LLC's National Provider Identifier is 1104875152, issued on May 8, 2006. The primary taxonomy on file is Skilled Nursing Facility (314000000X), and the practice location is in Seminole, FL. The record was last updated on Oct 3, 2014.