Mira Vie at Fanwood Opco LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

MIRA VIE AT FANWOOD OPCO LLC

Doing business as

Mira Vie at Fanwood

Practice address

295 South Ave
Fanwood, NJ 07023-1357

Phone

(908) 654-5200

Fax

(844) 808-0071

NPI assigned

May 7, 2024

Last updated

Aug 16, 2024By 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

Billie Abreu

Title

Director of Admin

Phone

(813) 330-2660

Specialties & licenses 1

Addresses

Other names 1

• Mira Vie at Fanwood Doing business as

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

{
    "created_epoch": "1715040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1952159865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 ANCHOR PLAZA PKWY STE 300",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336347521",
            "telephone_number": "813-330-2660",
            "fax_number": "844-808-0071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 SOUTH AVE",
            "city": "FANWOOD",
            "state": "NJ",
            "postal_code": "070231357",
            "telephone_number": "908-654-5200",
            "fax_number": "844-808-0071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRA VIE AT FANWOOD OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-07",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "ABREU",
        "authorized_official_first_name": "BILLIE",
        "authorized_official_title_or_position": "DIRECTOR OF ADMIN",
        "authorized_official_telephone_number": "813-330-2660"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mira Vie at Fanwood",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Fanwood, NJ
• Providers in Fanwood, NJ by specialty
• Assisted Living Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; 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.