Organization
CCRC OPCO - FREEDOM SQUARE, LLC
Active
Parent organization
BROOKDALE SENIOR LIVING INC
Other names
Freedom Square Rehabilitation & Nursing Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
BROOKDALE SENIOR LIVING INC
Authorized official
MS. MIKI C. STATES (ADMINISTRATOR)
(727) 398-0166
Entity
Organization
Contact information
Practice address
10801 JOHNSON BLVD, SEMINOLE, FL 33772-4746
(727) 398-0166
Mailing address
10801 JOHNSON BLVD, SEMINOLE, FL 33772-4746
(727) 398-0166
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF1167096
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
032424800
—
FL
Enumeration date
05/09/2006
Last updated
02/10/2022
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