Provider Demographics
NPI:1902654718
Name:MIRA VIE AT MONTVILLE OPCO LLC
Entity Type:Organization
Organization Name:MIRA VIE AT MONTVILLE OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABREU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-330-2660
Mailing Address - Street 1:4301 ANCHOR PLAZA PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7521
Mailing Address - Country:US
Mailing Address - Phone:813-330-2660
Mailing Address - Fax:
Practice Address - Street 1:165 CHANGEBRIDGE RD
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9563
Practice Address - Country:US
Practice Address - Phone:973-402-1100
Practice Address - Fax:844-808-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility