Healthcare Provider Details

I. General information

NPI: 1568339935
Provider Name (Legal Business Name): FORT MYERS SL OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9461 HEALTHPARK CIR
FORT MYERS FL
33908-3614
US

IV. Provider business mailing address

1775 HANCOCK ST STE 200
SAN DIEGO CA
92110-2036
US

V. Phone/Fax

Practice location:
  • Phone: 239-219-1600
  • Fax:
Mailing address:
  • Phone: 619-296-9000
  • 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 Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: CARL KNEPLER
Title or Position: OWNER
Credential:
Phone: 619-296-9000