Provider Demographics
NPI:1437954377
Name:PLATINUM RESORT 103 LLC
Entity type:Organization
Organization Name:PLATINUM RESORT 103 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOTKEVYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-773-6074
Mailing Address - Street 1:7723 SQUIRREL HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 MESA DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-1507
Practice Address - Country:US
Practice Address - Phone:512-580-8037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLATINUM RESORT MANAGEMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility