Healthcare Provider Details

I. General information

NPI: 1184879173
Provider Name (Legal Business Name): ASSISTED LIVING OF DUNEDIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 HOWELL ST
DUNEDIN FL
34698-4925
US

IV. Provider business mailing address

534 HOWELL ST
DUNEDIN FL
34698-4925
US

V. Phone/Fax

Practice location:
  • Phone: 727-453-1970
  • Fax: 727-736-4957
Mailing address:
  • Phone: 727-453-1970
  • Fax: 727-736-4957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberAL 7292
License Number StateFL

VIII. Authorized Official

Name: MARYLA B HAWEKOTTE
Title or Position: ADMINISTRATOR
Credential:
Phone: 727-453-1970