MEDICARE: ARDEN COURTS OF FT MYERS FL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215184023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARDEN COURTS OF FT MYERS FL LLC

Provider Business Mailing Address
First Line	:	333 N SUMMIT ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43604-1531
Country	:	US
Telephone Number	:	419-252-5541
Fax Number	:	419-254-5494

Provider Business Practice Location Address
First Line	:	15950 MCGREGOR BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-2551
Country	:	US
Telephone Number	:	239-454-1277
Fax Number	:	239-454-3785

Authorized Official
Title or Position	:	VICE PRESIDENT-REIMBURSEMENT
Name	:	MR. BARRY A LAZARUS
Credential	:
Telephone Number	:	419-252-5541

Provider Enumeration Date	:	08/22/2008
Last Update Date	:	08/22/2008

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