Watermark Boca Ciega Bay, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL83 Issued in FL

Legal business name

WATERMARK BOCA CIEGA BAY, LLC

Practice address

1255 Pasadena Ave S
South Pasadena, FL 33707-6203

Phone

(727) 381-5411

NPI assigned

Mar 3, 2014

Organization subpart

No

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

Authorized official

Name

David Freshwater

Title

VP, Asst Treasurer, Asst Secretary

Phone

(520) 797-4000

Specialties & licenses 1

Addresses

Other names 1

• The Inn at the Fountains Doing business as

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

{
    "created_epoch": "1393804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437004800000",
    "number": "1790100501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1255 PASADENA AVE S",
            "city": "SOUTH PASADENA",
            "state": "FL",
            "postal_code": "337076203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 PASADENA AVE S",
            "city": "SOUTH PASADENA",
            "state": "FL",
            "postal_code": "337076203",
            "telephone_number": "727-381-5411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERMARK BOCA CIEGA BAY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-03",
        "last_updated": "2015-07-16",
        "status": "A",
        "authorized_official_last_name": "FRESHWATER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "VP, ASST TREASURER, ASST SECRETARY",
        "authorized_official_telephone_number": "520-797-4000"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL83",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Inn at the Fountains",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sushama Vazrala, M.D.
• Jennifer Ann Villarino, PHARM.D.
• Sabina Vlaeva, DMD
• Wal-Mart Stores East LP
• Yue Wang, OMD
• Wayne J. Garcia Mdpa
• Mark Weiskopf
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• Wendy Lucker LLC
• West Florida - PPH, LLC

• Assisted Living Facility in South Pasadena, FL
• Providers in South Pasadena, 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 16, 2015; 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.