Provider Demographics
NPI:1447993779
Name:VOP MANGROVE BAY, LLC
Entity type:Organization
Organization Name:VOP MANGROVE BAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT FOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-673-4387
Mailing Address - Street 1:110 MANGROVE BAY WAY
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-6401
Mailing Address - Country:US
Mailing Address - Phone:561-575-3123
Mailing Address - Fax:
Practice Address - Street 1:110 MANGROVE BAY WAY
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-6401
Practice Address - Country:US
Practice Address - Phone:561-575-3123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility