Provider Demographics
NPI:1902568322
Name:CCRC DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:CCRC DEVELOPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMAAGE
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:407-543-6951
Mailing Address - Street 1:2110 HESTIA LOOP
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9274
Mailing Address - Country:US
Mailing Address - Phone:407-543-6350
Mailing Address - Fax:
Practice Address - Street 1:2110 HESTIA LOOP
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9274
Practice Address - Country:US
Practice Address - Phone:407-543-6951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility