CCRC Opco - Bradenton, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1168096 Issued in FL

Legal business name

CCRC OPCO - BRADENTON, LLC

Doing business as

The Nursing Center at Freedom Village

Practice address

6410 21St Ave W
Bradenton, FL 34209-7854

Phone

(941) 798-8200

Fax

(941) 798-8305

NPI assigned

Jul 4, 2006

Organization subpart

Yes

Parent organization

BROOKDALE SENIOR LIVING INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Mark W Ohlendorf

Title

President

Phone

(414) 918-5000

Specialties & licenses 1

Addresses

Other names 1

• The Nursing Center at Freedom Village Doing business as

Tax ID family

Arc Bradenton HC Inc2 organizations share this tax ID, including this one

Part of

Brookdale Senior Living Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• CCRC Opco - Bradenton, LLC

  dba Nursing Center at Freedom Village

  • Skilled Nursing Facility
  • Bradenton, FL
  • NPI 1417361858
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412294400000",
    "number": "1013947084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 WESTWOOD PL",
            "address_2": "SUITE 200",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275021",
            "telephone_number": "615-221-2250",
            "fax_number": "615-221-2269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6410 21ST AVE W",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342097854",
            "telephone_number": "941-798-8200",
            "fax_number": "941-798-8305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCRC OPCO - BRADENTON, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BROOKDALE SENIOR LIVING INC",
        "enumeration_date": "2006-07-04",
        "last_updated": "2014-10-03",
        "status": "A",
        "authorized_official_last_name": "OHLENDORF",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-918-5000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1168096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Nursing Center at Freedom Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ottavio P Catalano, M.D.
• Cathys Quality Care
• Denis M Cavanagh, MD
• Kristen Cavanaugh, OTR/L
• Nicholas Michael Cavis, RPH
• CCRC Opco - Bradenton, LLC (Nursing Center at Freedom Village)
• CDBR Enterprise LLC (Braden River Care Center)
• Jorge Enrique Ceballos I, DDS
• Nathalie Cecilia, LMT
• Miguel Angel Cedeno

• Skilled Nursing Facility in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.