Nic 5 Spring Haven Leasing LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

5504 Issued in FL

Legal business name

NIC 5 SPRING HAVEN LEASING LLC

Practice address

1225 NW Havendale Boulevard
Winter Haven, FL 33881

Phone

(863) 293-0072

Fax

(863) 294-4935

NPI assigned

Apr 29, 2013

Organization subpart

No

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

Authorized official

Name

Jane Ryu

Title

President/Ceo/Cfo

Phone

(212) 479-5270

Specialties & licenses 1

Addresses

Other names 1

• Spring Haven Retirement Community Doing business as

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

{
    "created_epoch": "1367193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480550400000",
    "number": "1992149397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1700, NIC 5 SPRING HAVEN LEASING LLC",
            "address_2": "C/O HOLIDAY RETIREMENT",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "97035",
            "telephone_number": "971-245-8020",
            "fax_number": "503-431-2295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 NW HAVENDALE BOULEVARD",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "33881",
            "telephone_number": "863-293-0072",
            "fax_number": "863-294-4935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NIC 5 SPRING HAVEN LEASING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-29",
        "last_updated": "2016-12-01",
        "status": "A",
        "authorized_official_last_name": "RYU",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "PRESIDENT/CEO/CFO",
        "authorized_official_telephone_number": "212-479-5270"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "5504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spring Haven Retirement Community",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tashanna Newman
• An Nguyen
• Kenny Nguyen, M.D.
• Nguyen Phuong Linh Helen Nguyen, PTA
• Darfrente Tuason Nibungco Jr., M.D.
• Mary Katherine Teisinger Nicholson, A.P., D.O.M.
• Nicole R. Klein DMD PA
• Jennifer Nicotra, MSW, LCSW
• Jesse Ning, OD
• Erin Nitz

• Assisted Living Facility in Winter Haven, FL
• Providers in Winter Haven, 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 Dec 1, 2016; 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.