God'S Vip Senior Haven, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

5448 Issued in FL

Legal business name

GOD'S VIP SENIOR HAVEN, LLC

Practice address

4681 SW 66TH Ave
Davie, FL 33314-4340

Phone

(954) 581-9111

NPI assigned

Mar 21, 2018

Organization subpart

No

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

Authorized official

Name

Robert Petras

Title

Coo

Phone

(260) 797-9482

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1521590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521590400000",
    "number": "1417451600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3630 ILLINOIS RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042062",
            "telephone_number": "708-309-0864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4681 SW 66TH AVE",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333144340",
            "telephone_number": "954-581-9111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOD'S VIP SENIOR HAVEN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-21",
        "last_updated": "2018-03-21",
        "status": "A",
        "authorized_official_last_name": "PETRAS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "260-797-9482"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "5448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCA",
            "identifier": "5448",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sophia Glen
• Suzanne Lynn Glenn, M.S. CCC-SLP
• Kelly A Glista
• Milla-Angelina N/a Gloria
• Gochiro LLC
• Lourdes Godomar, LMT
• Antonio Godoy, DDS., MS.
• Gods Vip Senior Haven, LLC
• Leah Goedecke, DO
• Hunter Goetz

• Assisted Living Facility in Davie, FL
• Providers in Davie, 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 Mar 21, 2018; 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.