202 Beverly LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

202 BEVERLY LLC

Doing business as

Refuge At New Life House

Practice address

202 Beverly Blvd
Brandon, FL 33511-5504

Phone

(678) 255-5990

NPI assigned

Jun 23, 2021

Last updated

Jul 5, 2023By 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

Miles Raynor Jr.

Title

Ceo

Phone

(678) 255-5990

Specialties & licenses 1

Addresses

Other names 1

• Refuge At New Life House Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1624406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688515200000",
    "number": "1386213320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 BEVERLY BLVD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115504",
            "telephone_number": "813-655-8454",
            "fax_number": "813-315-9379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 BEVERLY BLVD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115504",
            "telephone_number": "678-255-5990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "202 BEVERLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-23",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A",
        "authorized_official_last_name": "RAYNOR",
        "authorized_official_first_name": "MILES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-255-5990",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "refugecla@yahoo.com",
            "affiliation": "N",
            "endpointDescription": "refugecla@yahoo.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "202 Beverly Blvd",
            "city": "Brandon",
            "state": "FL",
            "country_code": "US",
            "postal_code": "335115504",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Refuge At New Life House",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Refuge At New Life House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Brandon, FL
• Providers in Brandon, 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 Jul 5, 2023; 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.