NPIMap

Organization Active NPI

CCRC Opco - Freedom Square, LLC

  • Skilled Nursing Facility
  • Seminole, FL
National Provider Identifier
1104875152
Registry record updated Oct 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
SNF14960961 Issued in FL
Legal business name
CCRC OPCO - FREEDOM SQUARE, LLC
Practice address
10800 Temple Terrace
Seminole, FL 33772-4736
Phone
(727) 398-0166
Fax
(727) 398-0188
NPI assigned
May 8, 2006
Organization subpart
Yes
Parent organization
BROOKDALE SENIOR LIVING INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 3, 2014

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

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X SNF14960961 FL Primary

Addresses

Primary practice location

10800 Temple Terrace
Seminole, FL 33772-4736

Mailing address

10800 Temple Terrace
Seminole, FL 33772-4736
Phone (727) 398-0166

Other identifiers 1

IdentifierTypeStateIssuer
032423000MedicaidFL

Other names 1

  • Seminole Pavilion 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": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412294400000",
    "number": "1104875152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10800 TEMPLE TERRACE",
            "city": "SEMINOLE",
            "state": "FL",
            "postal_code": "337724736",
            "telephone_number": "727-398-0166",
            "fax_number": "727-398-0188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10800 TEMPLE TERRACE",
            "city": "SEMINOLE",
            "state": "FL",
            "postal_code": "337724736",
            "telephone_number": "727-398-0166",
            "fax_number": "727-398-0188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCRC OPCO - FREEDOM SQUARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BROOKDALE SENIOR LIVING INC",
        "enumeration_date": "2006-05-08",
        "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": "SNF14960961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "032423000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Seminole Pavilion 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 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.