Organization
BRANDON SLC OPCO, LLC
Active
Other names
The Club at Brandon
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PILAR CARVAJAL (MANAGER)
(305) 428-2480
Entity
Organization
Contact information
Practice address
3918 S KINGS AVE, BRANDON, FL 33511-7749
(813) 662-1535
Mailing address
941 W MORSE BLVD STE 100, WINTER PARK, FL 32789-3781
(305) 428-2480
(305) 428-2480
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000000000
—
FL
Enumeration date
01/03/2023
Last updated
05/15/2023
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