NPIMap

Organization Active NPI

CCRC Opco - Freedom Square, LLC

  • Skilled Nursing Facility
  • Seminole, FL
National Provider Identifier
1033168992
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
SNF1167096 Issued in FL
Legal business name
CCRC OPCO - FREEDOM SQUARE, LLC
Practice address
10801 Johnson Blvd
Seminole, FL 33772-4746
Phone
(727) 398-0166
NPI assigned
May 9, 2006
Organization subpart
Yes
Parent organization
BROOKDALE SENIOR LIVING INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

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

Authorized official

Name
Ms. Miki C. States
Title
Administrator
Phone
(727) 398-0166

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X SNF1167096 FL Primary

Addresses

Primary practice location

10801 Johnson Blvd
Seminole, FL 33772-4746

Mailing address

10801 Johnson Blvd
Seminole, FL 33772-4746
Phone (727) 398-0166

Other identifiers 1

IdentifierTypeStateIssuer
032424800MedicaidFL

Other names 1

  • Freedom Square Rehabilitation & Nursing Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Arc Freedom Square LLC4 organizations share this tax ID, including this one
Part of
Brookdale Senior Living Inc

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1033168992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10801 JOHNSON BLVD",
            "city": "SEMINOLE",
            "state": "FL",
            "postal_code": "337724746",
            "telephone_number": "727-398-0166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10801 JOHNSON BLVD",
            "city": "SEMINOLE",
            "state": "FL",
            "postal_code": "337724746",
            "telephone_number": "727-398-0166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCRC OPCO - FREEDOM SQUARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BROOKDALE SENIOR LIVING INC",
        "enumeration_date": "2006-05-09",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "STATES",
        "authorized_official_first_name": "MIKI",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "727-398-0166",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1167096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "032424800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Freedom Square Rehabilitation & Nursing Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Freedom Square Rehabilitation & Nursing Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seminole, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; 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.