GV-Ormond, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL7460 Issued in FL

Legal business name

GV-ORMOND, LLC

Doing business as

Grand Villa of Ormond Beach

Practice address

535 N Nova Rd
Ormond Beach, FL 32174-4405

Phone

(386) 673-5000

Fax

(386) 673-0168

NPI assigned

Apr 4, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Dennis Forte

Title

Manager

Phone

(727) 726-3980

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Grand Villa of Ormond Beach Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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

{
    "created_epoch": "1365033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365033600000",
    "number": "1326381609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13770 58TH ST N",
            "address_2": "SUITE 312",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337603759",
            "telephone_number": "727-726-3980",
            "fax_number": "727-726-5345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 N NOVA RD",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321744405",
            "telephone_number": "386-673-5000",
            "fax_number": "386-673-0168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GV-ORMOND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-04",
        "last_updated": "2013-04-04",
        "status": "A",
        "authorized_official_last_name": "FORTE",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "727-726-3980",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL7460",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000592000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Villa of Ormond Beach",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jay Christian Guido, M.D.
• Paul K Gulliksen, PT
• Marifrances Christine Gullo, ARNP
• Amol K Gupta, M.D.
• Sheila R Gupta
• Gwen Kotler LCSW
• Amy N Hackett, RPH
• Noha Hafez, PHARMD
• Susan Haizelden, ARNP
• Carol Ann Halal, LMHC

• Assisted Living Facility in Ormond Beach, FL
• Providers in Ormond Beach, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.