MEDICARE: STEWARD FLORIDA ALF 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	AL8134	FL

General Provider Information

NPI Number	:	1598299414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEWARD FLORIDA ALF LLC

Provider Business Mailing Address
First Line	:	111 HUNTINGTON AVE
Second Line	:	SUITE 1800
City	:	BOSTON
State	:	MA
Zip	:	02199-7610
Country	:	US
Telephone Number	:	617-419-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 WUESTHOFF DR
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-6842
Country	:	US
Telephone Number	:	321-255-6030
Fax Number	:	321-255-3075

Authorized Official
Title or Position	:	CFO
Name	:	MARK RICH
Credential	:
Telephone Number	:	617-419-4700

Provider Enumeration Date	:	04/18/2017
Last Update Date	:	04/18/2017

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