MEDICARE: CORRIGAN PLACE, ALF, INC.

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	11814	FL

General Provider Information

NPI Number	:	1982036125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORRIGAN PLACE, ALF, INC.

Provider Business Mailing Address
First Line	:	11420 CORRIGAN ST
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-4706
Country	:	US
Telephone Number	:	727-410-7966
Fax Number	:	352-200-5222

Provider Business Practice Location Address
First Line	:	11420 CORRIGAN ST
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-4706
Country	:	US
Telephone Number	:	727-410-7966
Fax Number	:	352-200-5222

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JENNIFER VARDELEON GUNN
Credential	:
Telephone Number	:	727-410-7966

Provider Enumeration Date	:	07/30/2013
Last Update Date	:	07/30/2013

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