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NPI Code Detail

MEDICARE: ESC NEW PORT RICHEY, LLC

MEDICARE: ESC NEW PORT RICHEY, 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
1311500000XAlzheimer Center (Dementia Center)AL7902FL
2310400000XAssisted Living FacilityAL7902FL

Other Identifiers

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

General Provider Information

NPI Number : 1861639585
Entity Type Code : Organization
Provider Name (Legal Business Name) : ESC NEW PORT RICHEY, LLC
Provider Business Mailing Address
First Line : 6737 W WASHINGTON ST
Second Line : SUITE 2300
City : MILWAUKEE
State : WI
Zip : 53214-5647
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3110 OAKBRIDGE BLVD E
Second Line :
City : LAKELAND
State : FL
Zip : 33803-5987
Country : US
Telephone Number : 863-647-1199
Fax Number : 863-647-9229
Authorized Official
Title or Position : EVP, CHIEF ADMIN. OFFICER
Name : BRYAN RICHARDSON
Credential :
Telephone Number : 615-564-8131
Provider Enumeration Date : 01/16/2009
Last Update Date : 05/13/2016

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Directions to “ESC NEW PORT RICHEY, LLC ” Practice Location

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