Provider Demographics
NPI:1730696600
Name:UNIVERSITY CENTER WEST OPERATING LLC
Entity type:Organization
Organization Name:UNIVERSITY CENTER WEST OPERATING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELEG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-810-6250
Mailing Address - Street 1:1881 79TH STREET CSWY APT 1801
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4275
Mailing Address - Country:US
Mailing Address - Phone:512-810-6250
Mailing Address - Fax:
Practice Address - Street 1:545 W EUCLID AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-6771
Practice Address - Country:US
Practice Address - Phone:386-734-9085
Practice Address - Fax:386-734-7120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility