- Enrollment id
- O20240118003391
- Enrollment state
- FL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1679252696
- Multiple npi flag
- N
- Ccn
- 105578
- Associate id
- 0244682896
- Organization name
- MIAMI ROAD OPCO LLC
- Doing business as name
- AVIATA AT THE SEA - HARBOR BEACH
- Incorporation date
- 2023-07-05
- Incorporation state
- FL
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- AVIATA AT THE SEA - HARBOR BEACH
- Affiliation entity name
- AVIATA HEALTH GROUP
- Affiliation entity id
- 745
- Address line 1
- 1615 MIAMI RD
- City
- FT LAUDERDALE
- State
- FL
- Zip code
- 333162933