CCRC Opco-Freedom Square, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CCRC OPCO-FREEDOM SQUARE, LLC

Doing business as

Seminole Pavillion Health Center

Practice address

10800 Temple Ter
Seminole, FL 33772-4736

Phone

(727) 398-0166

NPI assigned

Jun 25, 2014

Last updated

Feb 10, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeffrey Miller

Title

Ceo/President

Phone

(949) 407-0700

Specialties & licenses 1

Addresses

Other names 1

• Seminole Pavillion Health Center Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1403654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612915200000",
    "number": "1225443583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 MAIN ST STE 1200",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926147230",
            "telephone_number": "949-407-0700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10800 TEMPLE TER",
            "city": "SEMINOLE",
            "state": "FL",
            "postal_code": "337724736",
            "telephone_number": "727-398-0166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCRC OPCO-FREEDOM SQUARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-25",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "949-407-0700"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Other",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Seminole Pavillion Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Emmett Caskey
• Lester Castillo, DMD
• Catherine L. Bourne, MSW
• CCRC Opco - Freedom Square, LLC (Freedom Square Rehabilitation & Nursing Services)
• CCRC Opco - Freedom Square, LLC (Seminole Pavilion Rehabilitation & Nursing Services)
• CCRC Opco-Freedom Square, LLC (Freedom Square Health Care Center)
• Annika Chadee, MD
• Robin Yvonne Chaloune, LMHC
• Sharilyn Rose Chappell, PA C
• Marilynn G Chauhan, RPT

• Skilled Nursing Facility in Seminole, FL
• Providers in Seminole, 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 Feb 10, 2021; 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.