Healthcare Provider Details

I. General information

NPI: 1184542458
Provider Name (Legal Business Name): NH ASL DUNEDIN TENANT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 GREENBRIAR BLVD
CLEARWATER FL
33763-1454
US

IV. Provider business mailing address

1585 BROADWAY FL 33
NEW YORK NY
10036-0473
US

V. Phone/Fax

Practice location:
  • Phone: 727-735-6200
  • Fax:
Mailing address:
  • Phone: 212-761-3649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: JAMES HICKOK
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 212-761-3649