Healthcare Provider Details

I. General information

NPI: 1306278676
Provider Name (Legal Business Name): SENIOR FRIENDSHIP CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5272 SUMMERLIN COMMONS WAY SUITE 604
FORT MYERS FL
33907-2156
US

IV. Provider business mailing address

5272 SUMMERLIN COMMONS WAY SUITE 604
FORT MYERS FL
33907-2156
US

V. Phone/Fax

Practice location:
  • Phone: 239-275-1881
  • Fax: 239-275-1077
Mailing address:
  • Phone: 239-275-1881
  • Fax: 239-275-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9173
License Number StateFL

VIII. Authorized Official

Name: NANCY GREEN-IRWIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 239-275-1881