MEDICARE: CANARY HOMES ASSISTED LIVING

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

General Provider Information

NPI Number	:	1972448959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANARY HOMES ASSISTED LIVING

Provider Business Mailing Address
First Line	:	271 SHERBOURNE ST
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33954-1741
Country	:	US
Telephone Number	:	941-322-7903
Fax Number	:	941-979-9110

Provider Business Practice Location Address
First Line	:	271 SHERBOURNE ST
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33954-1741
Country	:	US
Telephone Number	:	941-322-7903
Fax Number	:	941-979-9110

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. MARSHA MOORE
Credential	:
Telephone Number	:	941-322-7903

Provider Enumeration Date	:	04/23/2026
Last Update Date	:	04/23/2026

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