Healthcare Provider Details

I. General information

NPI: 1790617801
Provider Name (Legal Business Name): PINELLAS ASSISTED LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11479 ULMERTON RD
LARGO FL
33778-1602
US

IV. Provider business mailing address

11479 ULMERTON RD
LARGO FL
33778-1602
US

V. Phone/Fax

Practice location:
  • Phone: 813-545-0682
  • Fax:
Mailing address:
  • Phone: 813-545-0682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT SCOTT BENNETT
Title or Position: COO
Credential: MBA
Phone: 813-545-0682