MEDICARE: A SUMMERVILLE HOMES ASSISTED LIVING 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	AL12616	FL

General Provider Information

NPI Number	:	1326433020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A SUMMERVILLE HOMES ASSISTED LIVING LLC

Provider Business Mailing Address
First Line	:	7933 INDIGO STREET
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023
Country	:	US
Telephone Number	:	954-589-1632
Fax Number	:	954-589-1334

Provider Business Practice Location Address
First Line	:	2440 SW 82 TERRACE
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025
Country	:	US
Telephone Number	:	954-589-1632
Fax Number	:	954-589-1334

Authorized Official
Title or Position	:	ADMINISTRATOR-VP
Name	:	MRS. CORREL ALBERTA WINT
Credential	:
Telephone Number	:	954-589-1632

Provider Enumeration Date	:	03/31/2015
Last Update Date	:	03/31/2015

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