NPIMap

Organization Active NPI

Extended Care Portfolio Tenant, LLC

Doing business as Pacifica Senior Living Creekside

  • Alzheimer Center (Dementia Center)
  • Pensacola, FL
National Provider Identifier
1932532942
Registry record updated Aug 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Alzheimer Center (Dementia Center)Taxonomy code 311500000X
License
AL9068 Issued in FL
Legal business name
EXTENDED CARE PORTFOLIO TENANT, LLC
Doing business as
Pacifica Senior Living Creekside
Practice address
9015 University Pkwy
Pensacola, FL 32514-5525
Phone
(850) 477-6400
NPI assigned
Aug 13, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2013

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

Authorized official

Name
Mindy Myers
Title
Manager
Phone
(727) 726-3980

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Alzheimer Center (Dementia Center) 311500000X AL9068 FL Primary

Addresses

Primary practice location

9015 University Pkwy
Pensacola, FL 32514-5525

Mailing address

13770 58TH St N
Suite 312
Clearwater, FL 33760-3759
Phone (727) 726-3980

Other names 1

  • Pacifica Senior Living Creekside Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Extended Care Portfolio Multistate Pool Tenant LLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1376352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376352000000",
    "number": "1932532942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13770 58TH ST N",
            "address_2": "SUITE 312",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337603759",
            "telephone_number": "727-726-3980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9015 UNIVERSITY PKWY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325145525",
            "telephone_number": "850-477-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENDED CARE PORTFOLIO TENANT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-13",
        "last_updated": "2013-08-13",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "MINDY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "727-726-3980"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "FL",
            "license": "AL9068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacifica Senior Living Creekside",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pensacola, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2013; 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.