Origin Hospitality LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL11478 Issued in FL

Legal business name

ORIGIN HOSPITALITY LLC

Doing business as

Silver Creek Assisted Living St. Cloud

Practice address

2910 Old Canoe Creek Rd
Saint Cloud, FL 34772

Phone

(407) 593-1524

Fax

(407) 593-1525

NPI assigned

Mar 26, 2013

Last updated

Sep 25, 2019By 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

Mr. Mitesh Patel

Title

Managing Member

Phone

(832) 385-2295

Specialties & licenses 1

Addresses

Other names 1

• Silver Creek Assisted Living St. Cloud Doing business as

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

{
    "created_epoch": "1364256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569369600000",
    "number": "1841532025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17503 LA CANTERA PKWY #104618",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78257",
            "telephone_number": "832-385-2295",
            "fax_number": "855-557-2835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2910 OLD CANOE CREEK RD",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "34772",
            "telephone_number": "407-593-1524",
            "fax_number": "407-593-1525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORIGIN HOSPITALITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-26",
        "last_updated": "2019-09-25",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "MITESH",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "832-385-2295",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL11478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Silver Creek Assisted Living St. Cloud",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Saint Cloud, FL
• Providers in Saint Cloud, 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 Sep 25, 2019; 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.