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NPI Code Detail

MEDICARE: SUMMERVILLE 14, LLC

MEDICARE: SUMMERVILLE 14, 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
1310400000XAssisted Living FacilityAL9322FL

General Provider Information

NPI Number : 1801124201
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUMMERVILLE 14, LLC
Provider Business Mailing Address
First Line : 3131 ELLIOTT AVE STE 500
Second Line :
City : SEATTLE
State : WA
Zip : 98121-1032
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 26850 S BAY DR
Second Line :
City : BONITA SPRINGS
State : FL
Zip : 34134-4379
Country : US
Telephone Number : 239-948-2600
Fax Number :
Authorized Official
Title or Position : LICENSING SPECIALIST
Name : NOELLE BICKEL
Credential :
Telephone Number : 206-298-2909
Provider Enumeration Date : 11/23/2009
Last Update Date : 11/23/2009

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Directions to “SUMMERVILLE 14, LLC ” Practice Location

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