Brandon SLC Opco, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

BRANDON SLC OPCO, LLC

Practice address

3918 S Kings Ave
Brandon, FL 33511-7749

Phone

(813) 662-1535

NPI assigned

Jan 3, 2023

Organization subpart

No

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

Authorized official

Name

Mrs. Pilar Carvajal

Title

Manager

Phone

(305) 428-2480

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The Club at Brandon Doing business as

Locations

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

{
    "created_epoch": "1672704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684108800000",
    "number": "1942913157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "941 W MORSE BLVD STE 100",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327893781",
            "telephone_number": "305-428-2480",
            "fax_number": "305-428-2480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3918 S KINGS AVE",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335117749",
            "telephone_number": "813-662-1535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANDON SLC OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-03",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A",
        "authorized_official_last_name": "CARVAJAL",
        "authorized_official_first_name": "PILAR",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "305-428-2480",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00000000000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Club at Brandon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Brandon, FL
• Providers in Brandon, 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 May 15, 2023; 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.