Healthcare Provider Details

I. General information

NPI: 1881146876
Provider Name (Legal Business Name): RSC BRADENTON LANGDON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 33RD AVE W
BRADENTON FL
34205-6219
US

IV. Provider business mailing address

11230 33RD AVENUE WEST
BRADENTON FL
34205
US

V. Phone/Fax

Practice location:
  • Phone: 941-744-1923
  • Fax:
Mailing address:
  • Phone: 941-744-1923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL10661
License Number StateFL

VIII. Authorized Official

Name: GEREMY JORDAN
Title or Position: MGR
Credential:
Phone: 954-613-2300