Beachside Living LLC

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

10156 Issued in FL

Legal business name

BEACHSIDE LIVING LLC

Practice address

420 N Riverside Dr
Pompano Beach, FL 33062-5035

Phone

(954) 788-8350

NPI assigned

Aug 24, 2017

Organization subpart

No

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

Authorized official

Name

Vadim Mezrin

Title

Owner

Phone

(908) 240-5854

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1503532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503532800000",
    "number": "1649797242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 N POMPANO BEACH BLVD APT 1104",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330625716",
            "telephone_number": "908-240-5854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 N RIVERSIDE DR",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330625035",
            "telephone_number": "954-788-8350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACHSIDE LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-24",
        "last_updated": "2017-08-24",
        "status": "A",
        "authorized_official_last_name": "MEZRIN",
        "authorized_official_first_name": "VADIM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-240-5854"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "FL",
            "license": "10156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility (Mental Illness) in Pompano Beach, FL
• Providers in Pompano Beach, FL by specialty
• Assisted Living Facility (Mental Illness) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2017; 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.